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.
Saturday, 22 February 2014
A Tibetan fairy tale in Beijing: woman has stroke but has no family to pay medical fees
There was a happy ending for a 19-year old Tibetan woman called Dorje Tso who had a stroke while living in Beijing. The woman was taken into the Xuanwu hospital over Chinese New Year by friends when she showed signs of a severe stroke, which is unusual at that age. Doctors did a CT scan and diagnosed an embolism that required immediate treatment. However, the young woman had no money and no family with her to assent to the treatment while she was in a coma. Doctors tried calling her family in Qinghai but her parents were unable to speak Mandarin, only Tibetan. With only a four hour treatment window, they then desperately tried calling her sister who was in Shenzhen. However, the sister believed the call was a hoax and did not believe the request for medical fees was genuine, but a scam. One of the surgeons then took pictures of the Tibetan patient in the hospital with his mobile phone and texted them as a phone message to the daughter, who eventually agreed to her sister having treatment. Neurosurgeons then operated on Dorje and were able to remove the embolism, after which she made a good recovery. One of the doctors involved in the operation told the story on WeChat and it created great interest. One netizen was so moved by the story that he offered several thousand yuan to pay Dorje's medical bills.
Mianyang hospital doctors strike in protest against 'Corridor doctor' whistleblower
The long running saga of the Sichuan 'whistleblower doctor' took another twist this week as her colleagues staged a stop work meeting and mounted a noisy demonstration in Mianyang. They complained that the doctor's widely-aired allegations of overservicing and bad medical practice at the hospital were untrue and had besmirched their reputation. Police were called to the demonstration by medical staff as they became angry and shouted for her to be expelled from the hospital. They said the doctor's allegations had ruined the reputation of the hospital and resulted in it being downgraded, despite an official investigation finding no wrongdoing. Her allegations had also resulted in doctors at the hospital being abused and ridiculed, they said. Her claims of poor medical practice had stuck to individual members of staff who now found it hard to work because patients no longer trusted them, they added. Dr Lan Yuefeng claimed to have been stood down from her position in the ultrasound department after she refused to agree to overtreatment of patients. She became a media star when she carried on working in a corridor for almost two years after being turned out of her office.
Friday, 21 February 2014
Medical news - seven China links
1. With more than 10,000 new cases of HIV a year, Yunnan is to fund more NGO anti-HIV programs and improve healthcare for people with the infection.
2. New regulations on genome sequencing are to stop clinics ripping off consumers by offering the sequencing as part of routine health checks or to help predict children’s potential abilities, officials say.
3. Malnutrition is still a major problem in some parts of rural China, with one in every five children under the age of five years in poor areas needing better nutrition. Local governments have been set a benchmark of 29 kg per capita meat consumption standard to benefit children in underdeveloped region.
4. Pilot schemes have been set up in 27 provinces to allow rural migrants to claim medical insurance benefits away from their home town.
5. About 13 million deaths from smoking-related illness could be avoided if China adopted WHO recommendations on tobacco control, a paper in the BMJ says.
6. Adverse effects from drugs - and especially antibiotics - are a major health burden for hospitals in China and also cost thousands a of yuan a year for hospitals and patients alike in extra care costs, a study has suggested.
7. Only 9% of boys and 2% of girls in China get the minimum amount of physical activity per week to maintain health, a study carried out in 11 cities has found.
2. New regulations on genome sequencing are to stop clinics ripping off consumers by offering the sequencing as part of routine health checks or to help predict children’s potential abilities, officials say.
3. Malnutrition is still a major problem in some parts of rural China, with one in every five children under the age of five years in poor areas needing better nutrition. Local governments have been set a benchmark of 29 kg per capita meat consumption standard to benefit children in underdeveloped region.
4. Pilot schemes have been set up in 27 provinces to allow rural migrants to claim medical insurance benefits away from their home town.
5. About 13 million deaths from smoking-related illness could be avoided if China adopted WHO recommendations on tobacco control, a paper in the BMJ says.
6. Adverse effects from drugs - and especially antibiotics - are a major health burden for hospitals in China and also cost thousands a of yuan a year for hospitals and patients alike in extra care costs, a study has suggested.
7. Only 9% of boys and 2% of girls in China get the minimum amount of physical activity per week to maintain health, a study carried out in 11 cities has found.
Thursday, 20 February 2014
China's 60 million "left behind" children face neglect and poor mental health
More than 60 million Chinese children have been 'left behind' by rural migrants who move to cities and these children suffer from neglect and mental health problems, a new study has shown.
Research conducted by Dr Zhao Xue of the Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University has found that almost 60% of children in the rural areas were 'left behind'. This was a much higher number than expected and reflected China's "explosive growth" and shift to urban centres.
The survey of almost 1700 'left behind' children in rural Anhui found that they had higher levels of neglect, higher levels of social anxiety, lower family function and poor quality of life compared to children who lived with their parents. The problems were worse for girls perhaps because in Chinese society they have lower status than boys and thus get little attention, receive less physical and emotional support and have worse lives than boys, the researchers said.
However, left behind children tended to have lower rates of physical abuse than children who lived with thir parents. This might be becuse the escaped the "education by sticks" beatings from parents, the study authors suggested.
"These findings suggest that "left behind children' are currently in a relatively disadvantaged situation in Changfeng county and require more help from the local government and society to improve their life environment," they concluded.
The findings are published in Acta Paediatrica.
Shenzhen clinics show over-prescribing of antibiotics can be curbed by removing financial incentives for doctors
by Michael Woodhead
Antibiotic prescribing fell significantly when Shenzhen community clinics severed their ties with hospitals and dropped the financial incentives to prescribe them, a study has shown.
Published in the journal Family Practice, the study by Dr Liang Xiaoyun and colleagues at Beijing Normal University shows that prescribing of antibiotics fell by about 10% when the governance model of community clinics in Shenzhen's Baoan district was changed by government in 2009. Under the new independent model, doctors no longer received financial incentives for prescribing. After the reform, the number of young children receiving antibiotics decreased by 9%. The costs of antibiotic prescriptions also fell because doctors tended to prescribe cheaper first generation antibiotics instead of more expensive newer drugs. The study authors said their findings showed that "changes in governance structure model can have positive effects on the antibiotic prescribing behaviour of providers. This short-term effect might have an important
implication for community health reform in China."
Antibiotic prescribing fell significantly when Shenzhen community clinics severed their ties with hospitals and dropped the financial incentives to prescribe them, a study has shown.
Published in the journal Family Practice, the study by Dr Liang Xiaoyun and colleagues at Beijing Normal University shows that prescribing of antibiotics fell by about 10% when the governance model of community clinics in Shenzhen's Baoan district was changed by government in 2009. Under the new independent model, doctors no longer received financial incentives for prescribing. After the reform, the number of young children receiving antibiotics decreased by 9%. The costs of antibiotic prescriptions also fell because doctors tended to prescribe cheaper first generation antibiotics instead of more expensive newer drugs. The study authors said their findings showed that "changes in governance structure model can have positive effects on the antibiotic prescribing behaviour of providers. This short-term effect might have an important
implication for community health reform in China."
Wednesday, 19 February 2014
Schistosomiasis in China
Schistosomiasis has been largely eradicated in China but there are still about a quarter of a million people infected and 30,000 Chinese people with advanced disease, a review states. Dr Chen Minggan of the National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, said that before 1950 the infection caused by Schistosoma japonicum was endemic in many parts of China and had a high death rate - sometimes wiping out whole villages. Eradication programs have been successful in most parts of China but there are still areas where the infection persists, especially around the Yangtze river, he writes in the journal Infectious Diseases of Poverty. Some people have acquired the infection from swimming in rivers where the eggs of Schistosoma japonicum are present. Others contract the disease from farm animals such as cows and pigs. While the disease is in decline in humans, animals such as water buffalo still provide a large reservoir for the infection, with at least 1.5 million animals infected. Therefore eradication programs muct now address this problem if the infection is to be completely eliminated in China, Dr Chen writes.
Clinical news in brief - from the journals
In 'grassroots' hospitals, knowledge about Parkinson's disease - its diagnosis and management - is very limited for both neurologists and patients, a study from the West China Hospital in Chengdu has shown. Neurologists lacked knowledge of non-motor symptoms, differential diagnosis, therapeutic strategy and appropriate indications of surgical treatment, although they were familiar with the motor symptoms of the disease.
Adenoviruses cause 10% of cases where children are hospitalised for severe diarrhoea in China, according to a study from the Capital Institute of Pediatrics, Beijing.
More than 95% of people in Jiangsu have inadequate levels of riboflavin in their diet, putting them at risk of anaemia, a study has shown.
High levels of arsenic in seafood - and especially shellfish - pose a risk to human health, researchers from Shandong have warned.
People with epilepsy who have been seizure free for at least two years may be able to come off their anti-epilepsy medication, neurologists in Chengdu has shown. In a study of 162 patents with epilepsy who slowly tapered off their medication, 23% had a recurrent seizure and had to re-commence medication.
Ovarian cancer is relatively uncommon in China and rates are in decline, a review by the Henan Cancer Research and Control Office has concluded.
Adenoviruses cause 10% of cases where children are hospitalised for severe diarrhoea in China, according to a study from the Capital Institute of Pediatrics, Beijing.
More than 95% of people in Jiangsu have inadequate levels of riboflavin in their diet, putting them at risk of anaemia, a study has shown.
High levels of arsenic in seafood - and especially shellfish - pose a risk to human health, researchers from Shandong have warned.
People with epilepsy who have been seizure free for at least two years may be able to come off their anti-epilepsy medication, neurologists in Chengdu has shown. In a study of 162 patents with epilepsy who slowly tapered off their medication, 23% had a recurrent seizure and had to re-commence medication.
Ovarian cancer is relatively uncommon in China and rates are in decline, a review by the Henan Cancer Research and Control Office has concluded.
Tuesday, 18 February 2014
Doctor bludgeoned to death by "revenge killer" former patient angry over nose job
The head of the ENT department at Qiqihar Beigang Hospital in Heilongjiang has been bludgeoned to death by an 18-year old youth who was dissatisfied with the treatment he received from the doctor.
According to Chinese media reports the young man surnamed Qi entered the hospital brandishing a 50cm steel pipe, which he used to bash in the face of Dr Sun Dongtao. A doctor who witnessed the attack said the young man bashed Dr Sun so violently in the face and throat that he was not recognisable. Despite receiving immediate treatment the 45-year old doctor died. The suspect was apprehended by police, who found he was a local high school student who had recently undergone treatment on his nose by Dr Sun but was dissatisfied. Police said he developed a deep feeling of resentment against Dr Sun and sought revenge.
Breaking news - China medical news in brief
by Michael Woodhead
Genetic sequencing to reveal inherited traits such as high risk breast cancer gene BRCA1 has been banned in China until adequate standards can be set, the Beijing News reports. The order was made by the China Food and Drug Administration (SFDA) and the National Health and Family Planning Commission. An official said DNA sequencing was being promoted by some clinics and companies at the costs of thousands of yuan to detect conditions such as cancer, but the testing technology had not been authorised or verified and the charges not standardised.
Rural patients with dementia or depression have death rates three to four times higher than those of their urban counterparts, a study from Anhui has found.
A shortage of blood group O supplies in Beijing has caused the cancellation of elective surgery for many patients. The Beijing Daily reports that a 47-year old man who required cardiac surgery had his operation postponed because there was no blood group O available, only the more common B group. The man's family tried to donate blood but they found they were all group B. A return to the man's home town to try find donors from friends and family also proved unsuccessful. The man and his family resorted to placing adverts in the Beijing newspapers to try solicit blood donations. Doctors said the New year period was always a time of blood donor shortages as the traditional sources of blood donation - students - went home for extended periods.
Chinese people are subject to far too many useless, dangerous and wasteful medical tests in routine check-ups, an article Global Times claims. Citing the experiences of a visiting US physician, the Times asks why so many tests such as X-rays are offered as art of compulsory regular medical check for employment and other purposes when there is little scientific evidence to support them. Chinese clinicians agreed, putting much of the blame on private clinics which they said offered 'warmer service' but which exaggerated the risk of illness and the need for investigations. Clinic staff often act more like sale people than doctors and they offer unnecessary tests to an unwary public who do not have the medical knowledge to make an informed decision, the experts said. One group has estimated that the health checks market will be worth 300 billion yuan ($49.44 billion) by 2020.
Will China go bust with new major illness medical insurance scheme?
By Michael Woodhead
In a major feature in today's Beijing News, health economists warn that China faces many problems in widening its medical insurance schemes to cover serious and catastrophic illness. These schemes will cover major illnesses such as cancer where the large medical expenses can often result in families falling into penury. Serious disease medical insurance schemes are currently being pilot tested in 27 provinces and 130 cities, but experts say the existing schemes are very varied in their operation, have mixed results and are often poorly managed, with little commitment from local authorities. The Chinese State Council has recently recommended that implementation be speeded up and has ordered all provinces to have serious illness medical insurance pilot programs up and running by June.
At present, almost 290 million Chinese people are theoretically covered by such catastrophic illness schemes that have funds of more than 600 million yuan. Under existing medical insurance programs the reimbursements for serious illness are meagre and not enough to cover even the most basic costs of treatment. The average reimbursement for urban residents is 258 yuan and for rural residents it is 148 yuan. Health economists say there is a danger that if not managed effectively, a more extensive insurance scheme could simply be like "throwing a cup of water on a blazing woodcart". They point to the widespread 'leakage' in the current medical insurance schemes, in which little of the government funding actually gets to benefit the patient. When the government introduced widespread basic health insurance a few years ago the funding was absorbed by hospitals and practitioners who inflated their fees and carried out unnecessary treatments that would attract reimbursements from the government funds.
Therefore experts say that any new scheme must come with strict supervision and conditions to ensure that providers and insurers do not abuse the scheme. Otherwise there is a danger that any such national scheme would become a bottomless pit into which money was poured but with little benefit.
They say current pilot schemes have proved disappointing, with many of them being incomplete and incompatible with other schemes in neighbouring areas. Many still offer inadequate reimbursement to patients with serious illness and many are underfunded to provide sufficient benefits.
There also needs to be provision for rare and expensive to treat illnesses such as Gaucher's Disease, they warn. Without this, patients and their families will still face ruinous expenses when someone becomes ill.
Monday, 17 February 2014
"China's Top 10 Hospital" Awards are fake and can be bought for 28,000 RMB
China's national broadcaster, CCTV, has exposed a scam in which an official-sounding organisation known as the China Hospital Management Society has been selling hundreds of 'Top 10 Hospital' awards for 28,000 Yuan apiece.
The expose on national television showed that the CHMS had made millions by 'selling' awards and it claimed to have connections with government bodies such as the National Health and Family Planning Commission. However these bodies have now issued a denial of any involvement and have called for a full investigation into the society and its fake awards.
On its webpage (now unavailable) the CHMA claimed to be a non-profit public organisation operating under the auspices of the NHFPC and the Ministry of Civil Affairs.
Just a few days ago the CHMA website was publicising the launch of its "2014 China Hospital Outstanding Manager Award" and also a "2014 Chinese Health Consumer Hospital Satisfaction and Trust Award". However, it did not say what the requirements or criteria for these awards were, only the closing date for nominations - April 8th.
In January, the CHMA convened a conference in Beijing entitled the "2013 China Hospital Management Science Award Ceremony", the main purpose of which was to award participants with prizes and awards. The conference prospectus states that the society's honorary office bearers hold leadership positions in many important official bodies. Reporters verified these names and the fact that they attended the ceremony in question. A sponsor of the awards commented that these heavyweight leaders required payment of expenses to attend.
The participation of these 'heavyweights" attracted many other organisations and individuals to attend the awards ceremony. According to the "Roll of Honour" there were 321 medals awarded. Administrative staff told CCTV that the awards organiser took in more than 10 million yuan per ceremony, and these awards have been offered twice a year for 4-5 years.
According to CCTV, participants who were willing to pay more could get more prestigious awards. Among the ten or so higher awards were the "All-China Top Ten People's Satisfaction and Trust Hospital" award and the "Top 10 Most Trusted Pharmaceutical Company" award.
A CCTV reporter attempted to follow the process of such award by enrolling in the awards system. Despite missing the entry date he received an official confirmation letter, confirming that his 'hospital' had won a "Top 10" award. To collect the prize trophy, certificate and medal he was told he had to pay 28,000 yuan.
There were about 300 participants in the awards of varying sizes. Some received one 'award' , others received several. The organiser said "if you say you are advanced you can be advanced, if you want to be outstanding, you can be outstanding, it can be rubber stamped if you pay more money."
The CCTV report said some winners of the 'awards' auctioned them off to others.
Those who bought the prizes said they had many uses, and could be put on display to fool the public. They said the ceremony allowed them to have their photos taken with the influential 'heavyweights' who were in charge of important departments and held high office, and would help them win tenders. Others said they bought many smaller awards for 4000 yuan at the ceremony and then sold them on to smaller subsidiary hospitals for a profit.
The China Hospital Management Society claimed to be operating under the supervision of the NHFPC, but there is no record of it on the NHFPC website. The NHFPC announced that the CHMS was not linked in any way to the department and it was not a legitimate assessment or rating organisation. The department said all bodies that conducted assessments, ratings and commendations in healthcare had to strictly adhere to standards and supervision. The so-called CHMS awards for top hospitals and outstanding performance were all invalid, it declared.
Editor's note: The CHMA appears to be a bogus version of the official Chinese Hospital Association whose website (cha.org.cn) and a list of genuine awards can be seen here. The CHA has published notices warning of the bogus CHMA.
Sunday, 16 February 2014
TCM fails for migraine | Quit advice ineffective | Rural migrants need HIV help
Chinese herbal medicines ineffective in migraine
Chinese herbal patent medicines are used by about 60% of people in China with migraines, but satisfaction rates with the effects are low, and western medicines prove much more effective, a study from Guangzhou has found. In a survey of 219 patients with migraine, researchers found that 58% had used Chinese patent medicines to treat acute attacks, but only 28% reported being satisfied with the results. About 35% reported being unsatisfied. In contrast, about 60% of patients were satisfied with the response they got from western medicines such as NSAIDs for migraine. The most commonly used Chinese herbal medicines were ones containing L. wallichii, Dahurian angelica root, and G. elata. Interestingly, few Chinese migraine patients used the triptans, which are recognised internationally as being the most effective treatments for migraine, according to the article in Pain Medicine.
Quit advice not working
Smoking cessation counselling is effective for Chinese smokers who have developed COPD but has little influence on asymptomatic smokers, research from Changsha has found. After receiving smoking cessation counselling, smoking abstinence rates at six months were 40% for people with COPD but only 10% for asymptomatic smokers, according to a research group from the Department of Respiratory Disease at the Second Xiangya Hospital, Central South University, Changsha.
Rural migrants missed in HIV prevention
HIV is likely to spread in China via migrant labourers and housemaids, who have low levels of knowledege about the disease and high rates of unsafe sex, researchers from Fudan University in Shanghai have warned. In a survey of 2700 rural migrants they found that more than 40% were ignorant of the facts and risks of HIV, and 6.2% had engaged in high-risk sex in the past 12 months. Only 3% of migrant workers had access to free HIV screening. Writing in BMC Public Health he researchers said migrants must be targeted with tailored educational programs pitched at a level they can understand. Rural migrants should also be given free condoms and given access to HIV testing and antiretroviral treatment, they urged.
Chinese herbal patent medicines are used by about 60% of people in China with migraines, but satisfaction rates with the effects are low, and western medicines prove much more effective, a study from Guangzhou has found. In a survey of 219 patients with migraine, researchers found that 58% had used Chinese patent medicines to treat acute attacks, but only 28% reported being satisfied with the results. About 35% reported being unsatisfied. In contrast, about 60% of patients were satisfied with the response they got from western medicines such as NSAIDs for migraine. The most commonly used Chinese herbal medicines were ones containing L. wallichii, Dahurian angelica root, and G. elata. Interestingly, few Chinese migraine patients used the triptans, which are recognised internationally as being the most effective treatments for migraine, according to the article in Pain Medicine.
Quit advice not working
Smoking cessation counselling is effective for Chinese smokers who have developed COPD but has little influence on asymptomatic smokers, research from Changsha has found. After receiving smoking cessation counselling, smoking abstinence rates at six months were 40% for people with COPD but only 10% for asymptomatic smokers, according to a research group from the Department of Respiratory Disease at the Second Xiangya Hospital, Central South University, Changsha.
Rural migrants missed in HIV prevention
HIV is likely to spread in China via migrant labourers and housemaids, who have low levels of knowledege about the disease and high rates of unsafe sex, researchers from Fudan University in Shanghai have warned. In a survey of 2700 rural migrants they found that more than 40% were ignorant of the facts and risks of HIV, and 6.2% had engaged in high-risk sex in the past 12 months. Only 3% of migrant workers had access to free HIV screening. Writing in BMC Public Health he researchers said migrants must be targeted with tailored educational programs pitched at a level they can understand. Rural migrants should also be given free condoms and given access to HIV testing and antiretroviral treatment, they urged.
About 50% of pig farmers in Guangdong have hepatitis E
Hepatitis E is endemic in the pig herds of Guangdong, and this is reflected in high rates of the infection among swine herders, a study shows. About 50% of pig farmers in Guangdong show serological evidence of hepatitis E infection, and 38% of the general population have been infected by the disease spread by the faecal route, according to findings published in PLOS One. The epidemiological study of Guangdong people bwas carried out by Dr Liang Huanbin and colleagues at the Ministry of Agriculture Key Laboratory of Animal Vaccine Development, College of Veterinary Medicine, South China Agricultural University, Guangzhou. It found that Hepatitis E infection rates were higher than in surrounding provinces such as Hunan (22%). The study also found that 60-90% of pig herds had the infection, which raised questions about the health risks of pork, the researchers said.
Saturday, 15 February 2014
HIV strain is more aggressive in China - professor
HIV may be more aggressive in China because many infections are caused by a more virulent strain of the virus seldom seen in other countries, Beijing researchers say. Professor Li Taisheng, an infectious diseases specialist at the Harmony Hospital in Beijing say the average time to progression from HIV to immune failure and AIDS is eight years in western countries, but as little as four years in China. The reason for this appears to be a special strain of HIV with a factor known as CRF01, he told the Jinghua Daily. He said a newly published study involving more than 200 HIV patients from across China showed that the more virulent virus was found in almost half of people with HIV.
"CRF01_AE, a predominant HIV-1 subtype in Chinese HIV-1 sexually infected patients, tends to be associated with fast progression to AIDS and advanced immunodeficiency, which might be ascribed to high proportion of X4 tropism. Further investigation of these risk factors may have significant implications to clinical practice and policy-making," his study published in the journal AIDS concluded.
"CRF01_AE, a predominant HIV-1 subtype in Chinese HIV-1 sexually infected patients, tends to be associated with fast progression to AIDS and advanced immunodeficiency, which might be ascribed to high proportion of X4 tropism. Further investigation of these risk factors may have significant implications to clinical practice and policy-making," his study published in the journal AIDS concluded.
News in brief: Saturday 15 February
China's widespread misuse and overuse of antibiotics needs to be curbed, according to an article published in the BMJ this week. Dr Li Yan who works at Nottingham Trent University in the UK, writes that pressure from patients and perverse financial incentives are just two of many factors that have contributed a high rate of antibiotic use that is ten times higher than that of the US. Antibiotic overuse leads to resistance and causes numerous adverse events, she says. New regulations introduced by the Chinese health department need to be fully implemented, she adds, and there also needs to be a major public education campaign to improve awareness about antibiotics and reduce demand, she suggests.
A Hunan official has been found guilty of selling fake medical licences to six "black (bogus) doctors" who had not passed any medical exams. The records department workers sold the medical licences for 45,000 yuan to people who set up private medical clinics and pharmacies. The official was sentenced to eight months in jail and the medical licences were cancelled, Xinhua reports.
Almost 16,600 Chinese people died of infectious diseases in 2013, with HIV being the main cause of death, the National Health and Family Planning Commission has announced. There were more than 6.4 million infectious disease cases reported, of which AIDS, tuberculosis, rabies, hepatitis and hemorrhagic fever were the most deadly diseases, while hepatitis, tuberculosis, syphilis, dysentery and gonorrhea were the most prevalent, ECNS reports.
A Hunan official has been found guilty of selling fake medical licences to six "black (bogus) doctors" who had not passed any medical exams. The records department workers sold the medical licences for 45,000 yuan to people who set up private medical clinics and pharmacies. The official was sentenced to eight months in jail and the medical licences were cancelled, Xinhua reports.
Almost 16,600 Chinese people died of infectious diseases in 2013, with HIV being the main cause of death, the National Health and Family Planning Commission has announced. There were more than 6.4 million infectious disease cases reported, of which AIDS, tuberculosis, rabies, hepatitis and hemorrhagic fever were the most deadly diseases, while hepatitis, tuberculosis, syphilis, dysentery and gonorrhea were the most prevalent, ECNS reports.
Family beat doctor and force him to kneel before dead patient's coffin
A medical dispute in Shaoxing took a bizarre turn when the relatives of a man who died of infection in hospital brought his coffin to the hospital and forced a doctor to kneel before it and kow-tow. The gang of family members then beat the doctor severely and also fought with police. Xinhua
reports that the family brought the man into hospital suffering from a
gallbladder complaint. He initially recovered slightly but then
developed a severe infection and died. Family members blamed the
hospital for his death and returned to hold a 'funeral' in the hospital
reception area. The laid wreaths there and brought the coffin of their
father. The family members caused a commotion, shouting and swearing,
and they grabbed a doctor who they made to kneel down before the coffin
for almost an hour. Then they beat the doctor so severely he required
hospital treatment. The assailants also fought with police before they
ran off. The incident has generated a lot of comment on social media
sites, with some people saying they sympathise with the family but their
violent actions were too much. Medical staff at the hospital are
outraged and say the attackers must be caught and tried for their
'disgusting and brutal behaviour. Local law enforcement official shave
told the family members to give themselves up.
Shenzhen "black doctors" performed unnecessary abortion
A 17-year old Shenzhen women says her healthy baby was aborted by an illegal clinic staffed
by unqualified staff (bogus or "black" doctors) who were only interested in making money for doing
an operation. The woman went to a private clinic in Shenzen when she
had minor bleeding during her pregnancy. The staff there did an
ultrasound and told her the fetus was dead and that she should have an
abortion. She did so, but was also told she needed additional surgery to
have tissue removed. In total she paid more than 4000 yuan. However,
her family became suspicious when they noted the 'doctors' at the clinic
had the same names as other local doctors. When they investigated
further, they found that the doctor who diagnosed' the stillborn fetus
did not exist. An investigation by the local health department confirmed
this - and found that some of the fake doctors involved in the incident
had assumed the names of real doctors who had previously worked in
Shenzhen. One doctor who did surgery proved to be genuine, but said she
had acted in good faith, accepting the referral and the information from
the fake was real. The fake doctors have since disappeared and the
clinic they worked at was fined 3000 yuan and given 18 demerit points.
The family of the girl complained that this was too lenient.
Hubei group protest forced psychiatric treatment of people without mental illness
Friday, 14 February 2014
"Fake" GPs in Shanghai | 5-in-1 vaccine shortage | Appointments by WeChat: China medical news for Friday 14 February
Shanghai appears to lead China in the introduction of family doctors, but many of the so-called general practitioners (GPs) are fake, says Zhu Shanzhu, the chairman of the Society of General Practice, Chinese Medical Association. In an article in Global Times, Dr Zhu says that Shanghai is on target to have a GP for every resident by 2020, when people will be able to register with a family doctor working out of their local community health centre. However, Dr Zhu says many of the family doctors assigned to the health centres are not true GPs because they are specialists such as surgeons. Shanghai must therefore commit to training doctors in family medicine, she said.
A second death has been reported from the novel influenza strain H10N8 in Jiangxi. According to Shanghai Daily, a 75-year-old man died in Nanchang. Health authorities have urged the public to stay away from live poultry.
Shortages of the popular paediatric 5-in-1 combination vaccine have been reported due to transport congestion and delays ove the Chinese New Year. The imported vaccine, made by Sanofi, immunises against diphtheria, tetanus, pertussis, polio and Haemophilus influenza Type B and costs around 600 yuan for each of the four doses. Parents prefer it over free domestic vaccines because it reduces the number of needles their child has from 12 to four.
Hospitals in Beijing are offering appointments and medical results via WeChat, ECNS reports. The social media service is being offered by 21 municipal hospitals to patients who sign up and obtain a password.
A Shaanxi woman claims one of her kidneys was secretly removed during an operation she had more than 20 years ago. The woman made the shock discovery that she was missing a kidney when she had a hospital scan for back pain. The only possible explanation was that it must have been removed when she had an operation on her ovaries 26 years previously, she told TV reporters. The woman returned to the hospital where she had the operation but they rejected her claims and denied all responsibility for the incident.
A hospital in Hainan is pioneering a new model of "treat first, pay later" care. The hospital in Haikou has dropped the usual registration system in which patients pay a deposit ahead of treatment. the hospital managers say the new system is more convenient, but relies of the trust of patients to pay for their treatment afterwards. Non-payers will be put on a black list and refused further treatment, they said.
A Beijing academic has called on the government to stop the tobacco industry's deceptive marketing of "low tar, less harmful" cigarettes. Professor Yang Gonghuan of the Department of Epidemiology and Statistics, Institute of Basic Medical Science, Chinese Academy of Medical Science, says the claim that low tar cigarettes are less harmful is incorrect. However the slogan is used by industry to encourage smokers to stay with the habit. Writing in Tobacco Control, he urges the government to "stop the execution of this deceptive strategy for tobacco marketing".
And a kidney specialist in Guangzhou has been praised in the Chinese media for continuing to work despite being confined to a wheelchair. Reports say Dr Ke continued seeing 20 patients a day at the PLA 458 Hospital over the Chinese New Year despite having broken her patella and being unable to walk. Patients praised the doctor but she said any of her colleagues would have done the same thing.
A second death has been reported from the novel influenza strain H10N8 in Jiangxi. According to Shanghai Daily, a 75-year-old man died in Nanchang. Health authorities have urged the public to stay away from live poultry.
Shortages of the popular paediatric 5-in-1 combination vaccine have been reported due to transport congestion and delays ove the Chinese New Year. The imported vaccine, made by Sanofi, immunises against diphtheria, tetanus, pertussis, polio and Haemophilus influenza Type B and costs around 600 yuan for each of the four doses. Parents prefer it over free domestic vaccines because it reduces the number of needles their child has from 12 to four.
Hospitals in Beijing are offering appointments and medical results via WeChat, ECNS reports. The social media service is being offered by 21 municipal hospitals to patients who sign up and obtain a password.
A Shaanxi woman claims one of her kidneys was secretly removed during an operation she had more than 20 years ago. The woman made the shock discovery that she was missing a kidney when she had a hospital scan for back pain. The only possible explanation was that it must have been removed when she had an operation on her ovaries 26 years previously, she told TV reporters. The woman returned to the hospital where she had the operation but they rejected her claims and denied all responsibility for the incident.
A hospital in Hainan is pioneering a new model of "treat first, pay later" care. The hospital in Haikou has dropped the usual registration system in which patients pay a deposit ahead of treatment. the hospital managers say the new system is more convenient, but relies of the trust of patients to pay for their treatment afterwards. Non-payers will be put on a black list and refused further treatment, they said.
A Beijing academic has called on the government to stop the tobacco industry's deceptive marketing of "low tar, less harmful" cigarettes. Professor Yang Gonghuan of the Department of Epidemiology and Statistics, Institute of Basic Medical Science, Chinese Academy of Medical Science, says the claim that low tar cigarettes are less harmful is incorrect. However the slogan is used by industry to encourage smokers to stay with the habit. Writing in Tobacco Control, he urges the government to "stop the execution of this deceptive strategy for tobacco marketing".
And a kidney specialist in Guangzhou has been praised in the Chinese media for continuing to work despite being confined to a wheelchair. Reports say Dr Ke continued seeing 20 patients a day at the PLA 458 Hospital over the Chinese New Year despite having broken her patella and being unable to walk. Patients praised the doctor but she said any of her colleagues would have done the same thing.
Thursday, 13 February 2014
News in brief: clinical studies from China
Measles is now rare in Guangzhou thanks to vaccination, but complete eradication will require vaccination of transient populations who now account for more than half of cases.
People who have a heart attack in China delay going to hospital for more than two hours, often because they don’t recognise the symptoms or their importance.
Chinese people consume dangerously high amounts of salt, with a Yantai study showing that 97% of men and 87% of women had intakes of over 6 g salt per day (mostly from added salt and soy sauce). Salt intake was related to high systolic blood pressure.
More than one in four new mothers in Guangzhou experience post-partum depression.
Compulsory routine infant vaccination with pneumococcal conjugate heptavalent vaccine would reduce pneumococcal disease in China by at least 32%, would prevent 2,682 deaths in the first five years of life and would save $1,190 million.
In rural China epilepsy goes untreated or undertreated in two out of three people with the condition, a Sichuan study has found. One third of people with epilepsy did not know about the disease and had not sought medical help.
The cultural pressure for gay men in China to marry means that their wives face a high risk of HIV and syphilis, researchers from Ningbo say. They found that only one in four gay men always used condoms with their wives, which explained HIV rates of more than 8% in women married to gay men.
Low vitamin A levels are linked to eye cysts (chalazia) in south west China
Weather has an important influence on measles transmission in China, with infection more likely after cold spells and during dry weather.
People who have a heart attack in China delay going to hospital for more than two hours, often because they don’t recognise the symptoms or their importance.
Chinese people consume dangerously high amounts of salt, with a Yantai study showing that 97% of men and 87% of women had intakes of over 6 g salt per day (mostly from added salt and soy sauce). Salt intake was related to high systolic blood pressure.
More than one in four new mothers in Guangzhou experience post-partum depression.
Compulsory routine infant vaccination with pneumococcal conjugate heptavalent vaccine would reduce pneumococcal disease in China by at least 32%, would prevent 2,682 deaths in the first five years of life and would save $1,190 million.
In rural China epilepsy goes untreated or undertreated in two out of three people with the condition, a Sichuan study has found. One third of people with epilepsy did not know about the disease and had not sought medical help.
The cultural pressure for gay men in China to marry means that their wives face a high risk of HIV and syphilis, researchers from Ningbo say. They found that only one in four gay men always used condoms with their wives, which explained HIV rates of more than 8% in women married to gay men.
Low vitamin A levels are linked to eye cysts (chalazia) in south west China
Weather has an important influence on measles transmission in China, with infection more likely after cold spells and during dry weather.
Wednesday, 12 February 2014
Shanghai hospitals' database hacked and records sold to drug companies
A 'mole' hacked into the databases of three major Shanghai hospitals using wireless laptops and extracted drug usage data that was sold to pharmaceutical company representatives, Eastday reports.
The Huangpu court has found two people guilty of fraud after they downloaded drug data from the three hospitals and sold it for 12,000 RMB to drug company contacts. One of the hackers worked in the technical department of one hospital, the other was a pharmacist. The hacker used a laptop computer while sat in a car in the carpark of the hospitals to hack into the wireless network. They were caught in July 2013 when IT staff noticed unauthorised users extracting data, and traced them to the nearby car park, where they were arrested by police. They were fined 5000 RMB and sentenced to one year in jail.
In the past, pharma companies would sometimes pay hospitals for the drug usage data, but this practice has been outlawed. The hackers made contact with drug company representatives and told them they could sell the information each month for 46 different drugs for 250 RMB per item. They emailed the data to the drug company employee, who will be tried separately for corruption.
China needs to act on overuse of intravenous infusions - BMJ
Action is needed to reduce China’s massive overuse of intravenous infusions for inappropriate indications, according to an article in the BMJ this week.
The timid steps taken so far by the Chinese government have done little to dent the widespread misuse of IV infusions, with as many as ten billion courses – or eight per person per year – being given, says Yuan Sanying of the West China Hospital, Sichuan University, Chengdu.
She says the government has recognised the problem and has acted to reduce financial incentives for prescribing infusions. However, there is still enormous pressure on doctors to set up IV infusions and the practice continues in most hospitals. Many hospitals even have dedicated infusion rooms, she notes.
Ms Yuan, who works as a nurse in the Department of Liver Surgery, says hospitals look like ‘infusion forests’ during cold weather spells as patients are treated with infusions for common respiratory ailments. And yet doctors acknowledge that most patients don’t need IV medication and could be better treated with oral remedies and rest.
The use of infusions is a major burden on hospital staff, with nurses reporting being overworked and diverted from other tasks as they spend half their working day setting up IV infusions. The Ministry of health has responded by monitoring the number of infusions and by banning some hospitals and doctors from earning commissions from the use of infusions. However, inappropriate is still driven by pressure from patients who believe that they will recover faster if they have an infusion. Doctors and nurses who refuse to provide infusions face getting into disputes with patients and their families, she says. Yuan Sanying says financial restrictions should be extended to all hospitals. She also recommends a public education campaign, similar to the ones that have discouraged the public from using antibiotics for viral illnesses.
Tuesday, 11 February 2014
Illegal Beijing bird markets the source of exported H5N1 influenza virus
A backstreet illegal poultry market stall in Beijing was the likely source of the highly pathogenic avian influenza A(H5N1) virus infection that killed a Canadian visitor, infectious disease specialists have suggested.
In January a 28-year old woman developed H5N1 infection on her return to Alberta after visiting Beijing. She died after developing neurological complications. It was assumed that she had picked up the infection in Beijing but it was reported that she had not had close contact with poultry while in the city.
However, the woman probably picked up the virus from one of many illegal poultry market stalls that exist in Beijing, according to Dr Yang Peng of the Beijing Center for Disease Prevention and Control. In a letter to the Journal of Infection this week, Dr Yang says the Canadian case was only the second such case of H5N1 to be linked to the city. He describes a similar case in which a 19-year old woman developed H5N1 infection and died in 2009. Analysis showed that the H5N1 virus was avian in origin and belonged to clade 2.3.4. The woman had bought a live healthy duck from a street market and she had prepared it for cooking. Dr Yang said poultry breeding and live markets were prohibited in Beijing, but illegal markets had sprung up in the suburbs, and these sold poultry reared in nearby Hubei and Tianjin districts.The stall area where the women bought the duck tested positive for H5N1, according to Dr Yang. He therefore suggested that the recent Canadian case of H5N1 may have occurred after the visitor passed through a street market or stall.
The findings "indicate that illegal and uninspected selling and transportation of live poultry from regions outside of Beijing may have posed a high risk on human infection with avian influenza in the general population of Beijing currently. The enhanced inspection of illegal selling of live poultry, the strict regulation of transporting live poultry from regions outside of Beijing, as well as health education on changing dietetic culture is greatly warranted in Beijing, in order to reduce the risk of infection with avian influenza viruses in the general population of Beijing including visiting foreigners," the letter concluded.
And in another development this week, the full genomic analysis of the Beijing-derived H5N1 case has been published in the Emerging Infectious Diseases. The analysis "provides valuable insight into the presence of mutations that may reflect adaptive changes, altered virulence, and/or transmission phenotype," the researchers said.
In January a 28-year old woman developed H5N1 infection on her return to Alberta after visiting Beijing. She died after developing neurological complications. It was assumed that she had picked up the infection in Beijing but it was reported that she had not had close contact with poultry while in the city.
However, the woman probably picked up the virus from one of many illegal poultry market stalls that exist in Beijing, according to Dr Yang Peng of the Beijing Center for Disease Prevention and Control. In a letter to the Journal of Infection this week, Dr Yang says the Canadian case was only the second such case of H5N1 to be linked to the city. He describes a similar case in which a 19-year old woman developed H5N1 infection and died in 2009. Analysis showed that the H5N1 virus was avian in origin and belonged to clade 2.3.4. The woman had bought a live healthy duck from a street market and she had prepared it for cooking. Dr Yang said poultry breeding and live markets were prohibited in Beijing, but illegal markets had sprung up in the suburbs, and these sold poultry reared in nearby Hubei and Tianjin districts.The stall area where the women bought the duck tested positive for H5N1, according to Dr Yang. He therefore suggested that the recent Canadian case of H5N1 may have occurred after the visitor passed through a street market or stall.
The findings "indicate that illegal and uninspected selling and transportation of live poultry from regions outside of Beijing may have posed a high risk on human infection with avian influenza in the general population of Beijing currently. The enhanced inspection of illegal selling of live poultry, the strict regulation of transporting live poultry from regions outside of Beijing, as well as health education on changing dietetic culture is greatly warranted in Beijing, in order to reduce the risk of infection with avian influenza viruses in the general population of Beijing including visiting foreigners," the letter concluded.
And in another development this week, the full genomic analysis of the Beijing-derived H5N1 case has been published in the Emerging Infectious Diseases. The analysis "provides valuable insight into the presence of mutations that may reflect adaptive changes, altered virulence, and/or transmission phenotype," the researchers said.
Woman needs six stitches after argument with doctor
A woman in the Sichuan town of Yibin has needed six stitches for a wound sustained after a fight with a doctor over a dirty cushion. The woman named Chen says she got into an argument with a doctor in the X-ray department after she asked him to swap the cushion on the bench because it had a bloodstain on it. The woman said that she took her 20-month old son to the hospital for a checkup when he had a cough and cold. When she took him into the X-ray room for a scan, she noticed the bloodstain on the cushion and asked the doctor to change it. However, the doctor refused and said "get on with it". When the woman took out some paper towels and started to clean the cushion, she says the doctor disappeared into side room. She admitted she swore at him in frustration and then the doctor came back and swore back at her. The argument erupted and she said the doctor struck her on the head, cutting it open and causing bleeding, for which she needed six stitches. The woman said she was eventually faced with a bill for 3000 yuan in medical costs and she is demanding compensation from the hospital.
When the Dr Li was contacted at the Huaxi city Renmin Hospital he gave a different story. he said there were some bloodstains from a traffic accident on the cushion that he had been trying to clean off, but the clinic was extremely busy and he was under a lot of pressure to examine a waiting room full of patients. He said the woman called Li had been in an argumentative and volatile mood and had shouted and swore at him before chasing him into the side room. He said he had not hit the woman but had pushed her away after she started brawling with him, and she had fallen and hit her head.
A hospital spokesman said he could not comment on the matter until a police investigation was completed.
Three things shock me about this story:
1. A dispute over a dirty cushion could result in a violent argument between a female and a male doctor.
2. A woman would take her infant with a minor illness like a cough and cold to a hospital and have the child exposed to high doses of radiation with needless chest X-rays.
3. The medical bill for a cough and cold (and stitches) could be as high as 3000 Yuan.
What health stories are Chinese people seeing in their media today?
Here are a few samples of the medical and health stories appearing in the Chinese press today (links are to Chinese language sources):
Beijing has introduced screening for H7N9 in high risk groups such as those working in poultry markets.
Cities have been told to strengthen reform of hospital system, and second-line regional hospitals to introduce reform pilot projects.
Overeating and drinking during the Chinese New year has resulted in a 4-fold rise in hospital treatment for gastric problems.
False rumour spread about Beijing women whose stomach 'exploded' after overeating.
Liaoning woman, 18, arrested and forced to make public confession adn apology for spreading false rumours on Weibo about the death of a person from H7N9 influenza.
Rural children have rates of underweight and growth retardation four times greater than those of urban Chinese children, according to NHFPC.
Violence against doctors in disputes with pateints has become so common it is 'normal' says Harbin emergency physician.
Will the expanded cover for major illness bankrupt the rural health insurance scheme?
Beijing has introduced screening for H7N9 in high risk groups such as those working in poultry markets.
Cities have been told to strengthen reform of hospital system, and second-line regional hospitals to introduce reform pilot projects.
Overeating and drinking during the Chinese New year has resulted in a 4-fold rise in hospital treatment for gastric problems.
False rumour spread about Beijing women whose stomach 'exploded' after overeating.
Liaoning woman, 18, arrested and forced to make public confession adn apology for spreading false rumours on Weibo about the death of a person from H7N9 influenza.
Rural children have rates of underweight and growth retardation four times greater than those of urban Chinese children, according to NHFPC.
Violence against doctors in disputes with pateints has become so common it is 'normal' says Harbin emergency physician.
Will the expanded cover for major illness bankrupt the rural health insurance scheme?
Monday, 10 February 2014
China's media lauds the "4 cent prescription doctor"
The Chinese-language version of the China Daily is lauding a Henan doctor who prescribed a treatment for a child's rash (an antihistamine) that cost only 4 cents. The cheap cure is seen as big news at a time when many Chinese are complaining about the high costs of medical treatment. The story is based on the overwhelming web response to the Weibo posting of a mother of a two-year-old child, who posted that she couldn't believe how cheap it had been for her child's treatment.
The Weibo post described how she took her child to see a doctor at the Zhengzhou People's Hospital No 3 paediatrics department. The female doctor there told her the rash was due to an allergy and she would prescribe an antihistamine called chlorpheniramine. Based on her previous experience with hospitals, the mother expected to pay several hundred yuan for a long course of medicines - and so she was very surprised when she only had to pay 4 fen for 4 tablets of the antihistamine. She was so impressed that she took a photo of her hospital bill. She was also doubtful that such a cheap treatment could work, and so was again surprised when her child made a quick recovery from the rash.
When she posted this on Weibo, her story and photo was immediately re-posted thousands of times, with netizens starting an online discussion about the high cost of treatment and the difficulties of getting to see a doctor. Many praised the doctor at the children's hospital and said such doctors were hard to find these days.
When a China Daily reporter tracked down Dr Qin Ruijuan, she said her 4 cent prescription was nothing special and that she had only been doing her duty. "Any other doctor in my position would have done the same thing," she said. Dr Qin said the antihistamine was the most appropriate drug for the condition and only a short course was needed.
Dr Qin said some patients believed that doctors made a lot of money in commissions when prescribing drugs and treatments, but this was not the case. She said there was no link between doctors' incomes and treatments ate her hospital, nor were there any targets or quotas.
The China Daily reporter wrote that this was supposed to be the case at all hospitals and a new directive from the National Health and Family Planing Commission issued in December had re-iterated this rule. This included a new series of prohibited practices in healthcare, known as the 'Nine Forbiddens' included taking commissions or kickbacks from prescribing and having quotas or targets for treatments and prescriptions.
However, the reporter noted that there was a trend for hospitals to stock newer and more expensive medications at the expense of cheaper medicines . This led to a situation where it was impossible for doctor to prescribe affordable medicines because they were not stocked by the pharmacy. And because the profits were so tiny with cheap drugs "manufacturers don't want to make them, pharmacies don't want to sell them and doctors don't want to use them".
Violence in healthcare take a strange turn: nurse beaten by intern for questioning his advice
Healthcare staff in China have become inured to the threat of violence from disgruntled patients and their relatives, but this week a nurse has been subject to a violent beating from an unexpected quarter - an intern in her own department.
The nurse called Li Mei (pseudonym) says she still can't make sense of what happened, but she believes it was because she expressed doubt about the medical advice provided by a new intern in her department called Dr Du Mou.
A Shaanxi newspaper reports that the nurse was working in the internal medicine department of the Railway Hospital at Lueyang, Shaanxi alongside a male intern.
The nurse gave an interview to a journalist while she was lying in bed with an obvious red welt across her swollen face. She said the young male doctor had punched her repeatedly in the face, chest and stomach and also kicked her. She said it was because she had reminded him that his medical advice for one seriously ill patient was incorrect.
"As soon as I finished speaking he hit and kicked me. I was just stunned and dizzy and left with ringing in my ears," she said.
The nurse said she was now so sick she was unable to breastfeed her one year old child.
The local police station said they had sent officers to attend the incident, but when they arrived and ascertained what had happened, they were told by hospital management that this was an internal hospital disciplinary matter and they need not get involved. The head of the department confirmed to the reporter that an incident did take place but he refused permission for media to speak to the intern involved, who was still on duty.
The hospital director said the hospital managers said they were taking the incident very seriously and treating the injured nurse as best they could. An investigation would look closely into the events and would handle the matter gravely. The intern who hit the nurse was a recent graduate from medical school who had not yet passed his one year probation period. The intern said the nurse had sworn at him and cursed his family and he had impulsively struck out and hit her just once. The manager said interns did not have prescribing rights or the authority to give medical advice without supervision form a qualified doctor. He understood the two parties gave very different versions of the incident and the hospital was now investigating.
The nurse called Li Mei (pseudonym) says she still can't make sense of what happened, but she believes it was because she expressed doubt about the medical advice provided by a new intern in her department called Dr Du Mou.
A Shaanxi newspaper reports that the nurse was working in the internal medicine department of the Railway Hospital at Lueyang, Shaanxi alongside a male intern.
The nurse gave an interview to a journalist while she was lying in bed with an obvious red welt across her swollen face. She said the young male doctor had punched her repeatedly in the face, chest and stomach and also kicked her. She said it was because she had reminded him that his medical advice for one seriously ill patient was incorrect.
"As soon as I finished speaking he hit and kicked me. I was just stunned and dizzy and left with ringing in my ears," she said.
The nurse said she was now so sick she was unable to breastfeed her one year old child.
The local police station said they had sent officers to attend the incident, but when they arrived and ascertained what had happened, they were told by hospital management that this was an internal hospital disciplinary matter and they need not get involved. The head of the department confirmed to the reporter that an incident did take place but he refused permission for media to speak to the intern involved, who was still on duty.
The hospital director said the hospital managers said they were taking the incident very seriously and treating the injured nurse as best they could. An investigation would look closely into the events and would handle the matter gravely. The intern who hit the nurse was a recent graduate from medical school who had not yet passed his one year probation period. The intern said the nurse had sworn at him and cursed his family and he had impulsively struck out and hit her just once. The manager said interns did not have prescribing rights or the authority to give medical advice without supervision form a qualified doctor. He understood the two parties gave very different versions of the incident and the hospital was now investigating.
Sunday, 9 February 2014
A note on China's 'guided news' in healthcare
Editor's note: In the three months that I have been translating Chinese-language medical and healthcare stories into English I've noticed that a clear pattern emerging. Every week or so a story theme emerges for stories across China, in which a certain issue is covered in slightly different ways by local media outlets. One clear example of this has been the shortage of doctors in certain specialities such as emergency medicine and paediatrics. Over a period of 10-20 days I would notice a crop of stories about paediatrician shortages emerging from right across the nation. Interestingly, each region would have its own angle on the issue: in Heilongjiang the local media might interview a hospital manager and get feedback about difficulties in recruiting new doctors. In Nanning, however, the local media might do a 'day in the life' type feature on the problems of being a paediatrician in a busy and understaffed children's ward. The overall message would be the same. I don't think I'm being too paranoid in thinking that this suggests a certain degree of 'guided news coverage' is being co-ordinated at a national level. In other words, a central media department is instructing regional media outlets that a certain issue must be highlighted in local news coverage. In the last few weeks I've noticed that there have been more stories about the costs of drugs and how hospitals and doctors are tackling the problems of overservicing and high drug prices (eg with the' corridor doctor' story). All these stories seem to be aimed at supporting the Chinese government's latest policy of curbing high drug prices and reining in hospital costs.
Here are a few examples of 'news themes' from the last few weeks:
Here are a few examples of 'news themes' from the last few weeks:
- Doctor shortages in emergency medicine and paediatrics.
- Overservicing by hospitals
- Drug prices too high - and corruption/kickbacks
- Violence against doctors - and the contributory factors of workforce supply and demand
- Medical insurance coverage to be extended
- Primary care clinic expansion
- Medical education reforms - internships
- Private investment in healthcare
Antibody vaccine for H7N9 is more effective than Tamiflu, say Shanghai researchers
translated by Michael Woodhead
Shanghai researchers say traditional inactivated vaccines cannot be developed against H7N9 but they have developed a gene vaccine which is more efficacious than Tamiflu against the virus.
According to an article in the Workers Daily, an antibody therapeutic vaccine that is effective against the current strain of H7N9 has been developed by Shanghai researchers and is now about to start clinical trials. Researchers at the Shanghai Public Health Clinical Centre Infectious Disease Research Institute said they had developed antibodies that were effective against H7N9 in vitro and they are now starting tests in humans.
Professor Xu Jianqing of the Infectious Disease Research Institute said that work on the vaccine began in April last year after the first major H7N9 influenza virus outbreaks. He said the team had made a breakthrough with a gene vaccine in December when they injected the vaccine into 30 mice infected with H7N9. After 30 days none of the mice had died and none had signs of H7N9 infection, which represented the first real proof of efficacy.
Professor Xu said many other research groups in China were doing H7N9 vaccine research but using traditional inactivated vaccines. However, he said experiments had shown time and again that compared to other influenza viruses, the H7 influenza virus was not amenable to being incorporated into an inactivated vaccine, as it was deformed by the chemicals used, rendering the immune response inadequate. Similar efforts by Dutch researchers to develop a vaccine against the H7N3 virus strain in 2003 were also a failure for a the same reason. This showed that inactivated vaccine technology was not going to catch on for the H7 virus, he said.
The Shanghai researchers had therefore taken the bold step of taking the most important genetic material from the H7N9 virus and implanting it into a mature vaccine carrier. This was the equivalent of putting it into a safe and inserting this into a cell, said Professor Xu. And because the virus structure was not destroyed by putting it into an egg albumen, it elicited a good immune response, he added.
Professor Xu said the new vaccine would be suitable for people at high risk of H7N9 such as those working in live poultry markets and household members.
Within Shanghai's R&D community the new H7N9 vaccine was seen as a breakthrough after an audacious attack. Xu Jianqing said the immune system of H7N9-infected people produced antibodies, and the sooner the body produced antibodies the better the prognosis. He added that Tamiflu was effective if given within the first few days of viral infection, as this was the 'empty' window before the body had started producing its own antibody. But after more prolonged infection Tamiflu quickly became ineffective, and drug resistance appeared quickly. Researchers were inspired to try using exogenous antibodies during this initial 'empty window' period when there was no natural H7N9 antibody being produced. The observed effects of the gene vaccine were clearly better than Tamiflu during this period, said Xu Jianqing. In fact, in 2003 during the SARS outbreak, there had also been small scale treatment models of experimental antibody treatment that were successful in curing a patient.
It is reported that at present the H7N9 antibody treatment has already successfully completed two phases of in-vitro testing and it is estimated that Phase 3 testing will be complete within one month. From among the 100+ types of antibody currently in testing the best will be selected for clinical use.
Shanghai researchers say traditional inactivated vaccines cannot be developed against H7N9 but they have developed a gene vaccine which is more efficacious than Tamiflu against the virus.
According to an article in the Workers Daily, an antibody therapeutic vaccine that is effective against the current strain of H7N9 has been developed by Shanghai researchers and is now about to start clinical trials. Researchers at the Shanghai Public Health Clinical Centre Infectious Disease Research Institute said they had developed antibodies that were effective against H7N9 in vitro and they are now starting tests in humans.
Professor Xu Jianqing of the Infectious Disease Research Institute said that work on the vaccine began in April last year after the first major H7N9 influenza virus outbreaks. He said the team had made a breakthrough with a gene vaccine in December when they injected the vaccine into 30 mice infected with H7N9. After 30 days none of the mice had died and none had signs of H7N9 infection, which represented the first real proof of efficacy.
Professor Xu said many other research groups in China were doing H7N9 vaccine research but using traditional inactivated vaccines. However, he said experiments had shown time and again that compared to other influenza viruses, the H7 influenza virus was not amenable to being incorporated into an inactivated vaccine, as it was deformed by the chemicals used, rendering the immune response inadequate. Similar efforts by Dutch researchers to develop a vaccine against the H7N3 virus strain in 2003 were also a failure for a the same reason. This showed that inactivated vaccine technology was not going to catch on for the H7 virus, he said.
The Shanghai researchers had therefore taken the bold step of taking the most important genetic material from the H7N9 virus and implanting it into a mature vaccine carrier. This was the equivalent of putting it into a safe and inserting this into a cell, said Professor Xu. And because the virus structure was not destroyed by putting it into an egg albumen, it elicited a good immune response, he added.
Professor Xu said the new vaccine would be suitable for people at high risk of H7N9 such as those working in live poultry markets and household members.
Within Shanghai's R&D community the new H7N9 vaccine was seen as a breakthrough after an audacious attack. Xu Jianqing said the immune system of H7N9-infected people produced antibodies, and the sooner the body produced antibodies the better the prognosis. He added that Tamiflu was effective if given within the first few days of viral infection, as this was the 'empty' window before the body had started producing its own antibody. But after more prolonged infection Tamiflu quickly became ineffective, and drug resistance appeared quickly. Researchers were inspired to try using exogenous antibodies during this initial 'empty window' period when there was no natural H7N9 antibody being produced. The observed effects of the gene vaccine were clearly better than Tamiflu during this period, said Xu Jianqing. In fact, in 2003 during the SARS outbreak, there had also been small scale treatment models of experimental antibody treatment that were successful in curing a patient.
It is reported that at present the H7N9 antibody treatment has already successfully completed two phases of in-vitro testing and it is estimated that Phase 3 testing will be complete within one month. From among the 100+ types of antibody currently in testing the best will be selected for clinical use.
Saturday, 8 February 2014
Vaccine for H7N9 | No smoking in medical centres | Cosmetic surgery boom among young Chinese
Vaccine developed for H7N9
Shanghai researchers say they have developed a "gene vaccine" for the H7N9 avian flu virus for humans that has succeeded in primary animal tests, according to Shanghai Daily. The claim was made by officials at an infection disease research body under the Shanghai Public Health Clinical Center
Now influenza H6 is a threat to humans
Yet another kind of avian influenza virus has been found to pose a threat to human health in China - this time it is H6. Researchers from Lanzhou tested samples from live poultry markets in southern China from 2008–2011 and found that among the 257 H6 strains tested, 87 viruses couldbind to human receptors. They found that there were 30 different H6 genotypes, showing that these viruses are actively circulating and reassorting in nature. "Our study demonstrates that the H6 avian influenza viruses pose a clear threat to human health and emphasizes the need for the continued surveillance and evaluation of the H6 influenza viruses circulating in nature," they concluded in the Journal of Virology.
Subway station radiation not a health threat
Operators of subway stations in cities such as Beijing and Chengdu say the radiation from security scanners poses no threat to human health. The doses from a typical security scan are equal to around 0.007 mSv per year if a person is scanned daily. This is lower than the safety standard of 1 mSv per person a year. Most X-rays are contained within the machines by protective curtains that block X-rays from escaping," and environmental expert told the Beijing Daily.
No smoking rule for medical centres
Doctors have been advised to deliver stronger anti-smoking messages to their patients ,according to ECNS. According to the report, doctors have been told by the National Health and Family Planning Commission to inquire and record the smoking history of patients during their initial diagnosis to help smokers quit. The NHFPC also says that there should be no smoking in medical establishment and medical workers are also asked not to put ashtrays in their offices. The NHFPC also recommends that smoking clinics be set up.
Cosmetic surgery rates highest in young people
Cosmetic surgery and other cosmetic procedures such as ear piercing have become very popular with young people during the holiday period, according to Xinhua. Many stalls in a Shenyang market offered ear, lip, tongue, nose and belly button piercing over the New Year holiday. The operators claimed to be trained nurses but failed to produce any medical license. A cosmetic surgeon said that there had been a rise in young people undergoing minor surgeries too, with children as young as eight or nine getting double-eyelid surgery to give them the appearance of larger or "Western" eyes.
Shanghai researchers say they have developed a "gene vaccine" for the H7N9 avian flu virus for humans that has succeeded in primary animal tests, according to Shanghai Daily. The claim was made by officials at an infection disease research body under the Shanghai Public Health Clinical Center
Now influenza H6 is a threat to humans
Yet another kind of avian influenza virus has been found to pose a threat to human health in China - this time it is H6. Researchers from Lanzhou tested samples from live poultry markets in southern China from 2008–2011 and found that among the 257 H6 strains tested, 87 viruses couldbind to human receptors. They found that there were 30 different H6 genotypes, showing that these viruses are actively circulating and reassorting in nature. "Our study demonstrates that the H6 avian influenza viruses pose a clear threat to human health and emphasizes the need for the continued surveillance and evaluation of the H6 influenza viruses circulating in nature," they concluded in the Journal of Virology.
Subway station radiation not a health threat
Operators of subway stations in cities such as Beijing and Chengdu say the radiation from security scanners poses no threat to human health. The doses from a typical security scan are equal to around 0.007 mSv per year if a person is scanned daily. This is lower than the safety standard of 1 mSv per person a year. Most X-rays are contained within the machines by protective curtains that block X-rays from escaping," and environmental expert told the Beijing Daily.
No smoking rule for medical centres
Doctors have been advised to deliver stronger anti-smoking messages to their patients ,according to ECNS. According to the report, doctors have been told by the National Health and Family Planning Commission to inquire and record the smoking history of patients during their initial diagnosis to help smokers quit. The NHFPC also says that there should be no smoking in medical establishment and medical workers are also asked not to put ashtrays in their offices. The NHFPC also recommends that smoking clinics be set up.
Cosmetic surgery rates highest in young people
Cosmetic surgery and other cosmetic procedures such as ear piercing have become very popular with young people during the holiday period, according to Xinhua. Many stalls in a Shenyang market offered ear, lip, tongue, nose and belly button piercing over the New Year holiday. The operators claimed to be trained nurses but failed to produce any medical license. A cosmetic surgeon said that there had been a rise in young people undergoing minor surgeries too, with children as young as eight or nine getting double-eyelid surgery to give them the appearance of larger or "Western" eyes.
Friday, 7 February 2014
Xian doctor uses WeChat to connect with patients
The Economic Reference (Jingji Cankao) magazine has a story about a Xian female doctor who has started using WeChat to keep in touch with her regular patients. 'Dr Hao' is described as a well known and respected family doctor from a medical family. She is a third generation doctor and has followed in the footsteps of her grandfather and both her parents in running a private clinic in the suburbs of Xian. Dr Hao specialised in child health but also 'inherited' a lot of older patients with chronic diseases from her parents. She was very popular patients because of her kind and patient manner and because she had a high standard of medical ethics.
However, to years ago the much loved Dr Hao Clinic had to close down when the block in which it was located was earmarked for demolition. Not only did Dr Hao lose her clinic, many of her local patients were also re-housed and dispersed to other areas. These patinets were especially upset at losing their 'personal doctor', and Dr Hao also felt worried about losing touch with them. Shen then hit on the idea of using WeChat (Weixin) to keep in touch. When she opened a new clinic she also opened an online channel to her patients via WeChat, the social networking site that she had until then used frequently to keep up with friends and family. Dr Hao spread the word that she could be contacted by WeChat - and she also started getting details from the patients who tracked her down to the new clinic. At each consultation Dr Hao would finish up by explaining WeChat to her older patients and if necessary even helping them register for it on their mobiles.
Now Dr Hao is back in touch with many of her patinets, especially those who live futher aay and find it hard to come and see her regularly. Dr Hao uses WeChat to find out about their medical condition and ho they are managing. She uses it to give advice to pateints and also to help them with their medication. She has now even registered a unique "Dr Hao Clinic" name on WeChat.
However, to years ago the much loved Dr Hao Clinic had to close down when the block in which it was located was earmarked for demolition. Not only did Dr Hao lose her clinic, many of her local patients were also re-housed and dispersed to other areas. These patinets were especially upset at losing their 'personal doctor', and Dr Hao also felt worried about losing touch with them. Shen then hit on the idea of using WeChat (Weixin) to keep in touch. When she opened a new clinic she also opened an online channel to her patients via WeChat, the social networking site that she had until then used frequently to keep up with friends and family. Dr Hao spread the word that she could be contacted by WeChat - and she also started getting details from the patients who tracked her down to the new clinic. At each consultation Dr Hao would finish up by explaining WeChat to her older patients and if necessary even helping them register for it on their mobiles.
Now Dr Hao is back in touch with many of her patinets, especially those who live futher aay and find it hard to come and see her regularly. Dr Hao uses WeChat to find out about their medical condition and ho they are managing. She uses it to give advice to pateints and also to help them with their medication. She has now even registered a unique "Dr Hao Clinic" name on WeChat.
Pollution decreases Chinese men's sperm | H5N1 virus carried by wild birds | Adenovirus threat to PLA | Tuberculosis control failing
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.
Thursday, 6 February 2014
Doctor attacked for refusing drip | National roaming needed for medical insurance | Community HIV testing | Hand, foot and mouth disease surveyed
Doctor assaulted for refusing to put feverish child on IV drip
China's unscientific obsession with IV infusions for every malady has been brought into focus by an assault on a doctor at a Shenzhen hospital. In a widely reported story, it was said that a family attacked a doctor at a Shenzhen children's hospital when the doctor refused to arrange an IV infusion for a one year old child with a cold. The child had been brought into the hospital by his parents and was given oral medication after it was found to be feverish and diagnosed with a viral respiratory tract infection. However, the family were not satisfied with the oral medication and went back to see the doctor to demand their child be given an 'infusion'. When the doctor refused, the child's father smacked him in the face several times until the doctor was bleeding from the mouth. The attack was only stopped after the intervention of security guards and nurses. The attacker was taken into police custody where he will remain for at least three days while his case is investigated.
Health insurance won't work for floating population
China's goal of providing universal national health insurance is being hampered by the huge 'floating population' of migrant workers, a report has found. While more than 90% of the population are now covered by some kind of medical insurance scheme, the reality is that China's 240 million 'floating population' cannot take advantage of their insurance because it is only valid in their home town or province. This means that many migrant workers and their families from rural and regional areas face large medical bills that they cannot get any compensation for. IN some cases, floating workers will return home to take advantage of medical facilities where they can get some reimbursement, the report said. Integration of China medical insurance schemes is fraught with difficulty because different provinces and cities have different insurance schemes with different premiums and entitlements, the report notes. This means that local hospitals and health insurance schemes are unwilling to deal with 'outside people'. The solution may be some kind of 'national roaming' scheme for health insurance, the report concludes
Community HIV testing a hit
Rapid HIV testing is well accepted and detects many HIV positive people when offered by community clinics in China to high risk patient , a study has shown. In a trial of rapid HIV testing involving 42 sites community health centres in China, 23,609 patients underwent HIV testing. The positive screening prevalence was 0.41%, which is higher than in general hospitals (0.17%). Published in PLOS One, the study findings provide concrete evidence to support the involvement of community health clinics in the expansion of HIV/AIDS testing and case finding, said the researchers from the National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing.
Hand foot and mouth disease surveyed
China's largest ever study of hand, foot, and mouth disease has shown that it is most common in June in north China, whereas southern China has semiannual outbreaks in May and September. The review of seven million cases cases of hand, foot, and mouth disease showed the annual incidence was 1·2 per 1000 person-years, of which 2457 (0·03%) were fatal. The incidence and mortality were highest in children aged 12-23 months, according to the study published in the Lancet Infectious Diseases.
Hypertension more common among Mongolians
A study carried out in northern China has found that hypertension is more common among ethnic Mongolians. Mongolian and Han populations in northeast China. In a study of 4753 Mongolian people and 20,247 Han people, rates of newly diagnosed hypertension over a four year period
were 12.64 per 100 person-years for Mongolians and 9.77 for Han. The rates of awareness of hypertension were low for both Mongolians (36.5%) and Han (42.3%) Likewise, rates of treatment (13.1% vs. 18.2%) and control of hypertension (0.7% vs. 1.3%),were low among both Mongolian and Han population, the study in PLOS One found.
Wednesday, 5 February 2014
Beijing stent success | COPD prevented | Private hospital investor reluctance | Generic companies head for the door
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.
Tuesday, 4 February 2014
China medical news for Tuesday 4 February
New medical drama wins TV audience
China's latest TV hit is "Love of O&G Department" (Aide Fuchanke, 爱的妇产科). The program about the lives and loves of five doctors in a hospital obstetrics and gynaecology department has been praised for its fresh approach, innovative style and good storylines. It features the usual mixture of love lives, fraught work relationships and dramas centred on patient stories and the success and failure of the doctors' treatments. The series is produced by the Hunan TV studios and has gained good feedback on Chinese social media sites such as Weibo. Many have praised it as being in the same glamorous and realistic style as US produced English language medical series such as Grey's Anatomy. It features famous actors such as Zhu Dan, He Chenming and Sun Jian.
Chilis lower insulin resistance
Eating chilis is beneficial for insulin resistance and may help ward off diabetes, Beijing researchers have shown. A study of 8433 adults done as part of the China Health and Nutrition Survey found that chili eating was associated with lower levels of insulin resistance compared to not eating chilis, for both males and females. The level of insulin resistance also related to the strength of chili food types (a little bit hot, moderately hot, and very hot), said researchers from the Sino Japanese hospital in Beijing. Their findings are published in the Journal of Medicinal Food.
Police pose as doctors to capture mentally ill man
Police in Liaoning posed as doctors to overcome a man with mental illness who had taken a women hostage. The man had kidnapped his aunt and held her hostage in an apartment in Benxi, where he threatened to burn the house down. When police came to the scene they learned that the man had been an inpatient at a mental hospital and trusted doctors. They therefore borrowed white coats and face masks, which they donned and approached the agitated man. They were able to approach him by calling soothing words and they were then able to enter the apartment and subdue him without any harm to the man or his hostage, the Huashang News reports.
Total smoking ban for China schools
The Ministry of Education has issued a tough smoking ban covering all the nation’s schools. IN a circular the ministry said smoking was completely forbidden for everyone everywhere within primary and middle schools, kindergartens and secondary vocational schools. Smoking-ban signs must be displayed in conspicuous places and smoking areas are banned. Stores in schools are prohibited from selling tobacco, and there must be no tobacco sponsorship or advertinsg. School principals will be held responsible for the ban’s implementation, according to the Beijing Daily.
Monday, 3 February 2014
Doctors warn that abortion is being used as a regular contraception method by many Chinese women
translated by Michael Woodhead
Private clinics are encouraging women to use abortion as a regular method of contraception, doctors in Guangxi have warned.
Some women are having as many as six abortions and putting themselves at risk of infertility and other complications because abortion is promoted by commercial clinics and hospitals as quick and risk-free method of managing unwanted pregnancy, according to an article in Straits Economic Online.
Dr Li Jingjing, deputy head of the obstetrics and gynaecology department at the Liuzhou Workers Hospital said she had seen women who had as many as 12 abortions because of ignorance about family planning methods and misinformation about abortion circulated by some clinics.
She said some women resorted to abortion because they had unwarranted fears about using oral contraceptives, believing they had harmful side effects. Other women without children said it was too early to consider tubal ligation and their husbands were unwilling to use condoms. Dr Li cited the recent example of a 28-year-old women who had already had six abortions and despite feeling it was 'not quite normal' had little idea of the harms it caused.
Dr Li said there were many such "ignorant and fearless" women and the number of repeat abortions was high, although there were no official statistics available. With 17 years experience in obstetrics and gynaecology, Dr Li said she found younger women were more and more indifferent to the use of abortion and some of them fell into the habit of using it a a regular method of contraception.
One of the reasons was the widespread advertising of "quick and painless abortion" services by private clinics and some hospitals. The adverts for these clinics, which promised "One sleep and it's all fixed - zero harm" were a kind of malpractice, said Dr Li.
A reporter visited several hospitals in Liuzhou and found that abortion was offered for 500-2000 yuan and promised to be painless and convenient. Some even offered '10 minute' procedures for abortion in early pregnancy. Hospital websites also featured prominent advertisements inviting women to have abortions, the reporter found. Hospital figures showed that 85% were first time abortion, 10% were second time and 4% were third abortions. This information confirmed that the abortion situation was 'chaotic', the reporter concluded.
Private clinics are encouraging women to use abortion as a regular method of contraception, doctors in Guangxi have warned.
Some women are having as many as six abortions and putting themselves at risk of infertility and other complications because abortion is promoted by commercial clinics and hospitals as quick and risk-free method of managing unwanted pregnancy, according to an article in Straits Economic Online.
Dr Li Jingjing, deputy head of the obstetrics and gynaecology department at the Liuzhou Workers Hospital said she had seen women who had as many as 12 abortions because of ignorance about family planning methods and misinformation about abortion circulated by some clinics.
She said some women resorted to abortion because they had unwarranted fears about using oral contraceptives, believing they had harmful side effects. Other women without children said it was too early to consider tubal ligation and their husbands were unwilling to use condoms. Dr Li cited the recent example of a 28-year-old women who had already had six abortions and despite feeling it was 'not quite normal' had little idea of the harms it caused.
Dr Li said there were many such "ignorant and fearless" women and the number of repeat abortions was high, although there were no official statistics available. With 17 years experience in obstetrics and gynaecology, Dr Li said she found younger women were more and more indifferent to the use of abortion and some of them fell into the habit of using it a a regular method of contraception.
One of the reasons was the widespread advertising of "quick and painless abortion" services by private clinics and some hospitals. The adverts for these clinics, which promised "One sleep and it's all fixed - zero harm" were a kind of malpractice, said Dr Li.
A reporter visited several hospitals in Liuzhou and found that abortion was offered for 500-2000 yuan and promised to be painless and convenient. Some even offered '10 minute' procedures for abortion in early pregnancy. Hospital websites also featured prominent advertisements inviting women to have abortions, the reporter found. Hospital figures showed that 85% were first time abortion, 10% were second time and 4% were third abortions. This information confirmed that the abortion situation was 'chaotic', the reporter concluded.
H7N9 may be confined to Chinese due to susceptibility gene?
by Michael Woodhead
A H7N9 influenza pandemic may be confined to Chinese people because of a susceptibility gene that makes them much more prone to severe H7N9 disease, a new review has noted.
The IFITM3 gene (interferon-induced transmembrane protein-3 gene) increases influenza disease severity, but it is uncommon among Caucasians, a report in the journal Clinical Infectious Diseases notes.
The IFITM3 gene is more common in Chinese people and could account for a widespread population risk of severe H7N9 infection, says Dr David Hui of the Chinese University of Hong Kong.
In a commentary on risk factors for H7N9, Dr Hui notes that recent research has shown that 70% of Chinese patients who had severe influenza infection had the susceptibility gene. The gene is associated with a six-fold higher risk of severe influenza, he notes, and has also been linked to higher influenza mortality. A genetic susceptibility may also explain clusters of the infection in family members.
The study released last year concluded that: "because the risk genotype occurs with such a high frequency [in Chinese people], its effect translates to a large population-attributable risk of 54.3% for severe infection in the Chinese population studied compared with 5.4% in Northern Europeans."
Dr Hui also remarks on another surprising finding from a new review of influenza patients: smoking appears to be protective against hospitalisation for the disease. This 'counter-intuitive finding' might be due to some anti-inflammatory effect of nicotine, he suggests.
The review found that H7N9 influenza tended to affect older men and those with co-morbidities such as cardiovascular disease. It also had a more protracted course than other forms of influenza, with an average time from onset to death of 18 days.
UPDATE: Another recent study has shown that compared to Caucasians, Chinese people have lower levels of an immune protective mechanism against H7N9 influenza virus known as CD8+ T lymphocyte (CTL) immunity. The same study also shows that Alaskan and Australian Indigenous people may be particularly vulnerable to H7N9.
A H7N9 influenza pandemic may be confined to Chinese people because of a susceptibility gene that makes them much more prone to severe H7N9 disease, a new review has noted.
The IFITM3 gene (interferon-induced transmembrane protein-3 gene) increases influenza disease severity, but it is uncommon among Caucasians, a report in the journal Clinical Infectious Diseases notes.
The IFITM3 gene is more common in Chinese people and could account for a widespread population risk of severe H7N9 infection, says Dr David Hui of the Chinese University of Hong Kong.
In a commentary on risk factors for H7N9, Dr Hui notes that recent research has shown that 70% of Chinese patients who had severe influenza infection had the susceptibility gene. The gene is associated with a six-fold higher risk of severe influenza, he notes, and has also been linked to higher influenza mortality. A genetic susceptibility may also explain clusters of the infection in family members.
The study released last year concluded that: "because the risk genotype occurs with such a high frequency [in Chinese people], its effect translates to a large population-attributable risk of 54.3% for severe infection in the Chinese population studied compared with 5.4% in Northern Europeans."
Dr Hui also remarks on another surprising finding from a new review of influenza patients: smoking appears to be protective against hospitalisation for the disease. This 'counter-intuitive finding' might be due to some anti-inflammatory effect of nicotine, he suggests.
The review found that H7N9 influenza tended to affect older men and those with co-morbidities such as cardiovascular disease. It also had a more protracted course than other forms of influenza, with an average time from onset to death of 18 days.
UPDATE: Another recent study has shown that compared to Caucasians, Chinese people have lower levels of an immune protective mechanism against H7N9 influenza virus known as CD8+ T lymphocyte (CTL) immunity. The same study also shows that Alaskan and Australian Indigenous people may be particularly vulnerable to H7N9.
China's rural health insurance scheme has failed: costs of treatment have gone up instead of down
by Michael Woodhead
China’s New Co-operative Medical Scheme has done the opposite of what it was intended to do: it has increased costs and reduced access to health services for rural people, a study has found.
The government-subsidised health insurance program for rural residents was introduced in 2003 and was designed to reduce out-of-pocket payments for hospital treatment for rural Chinese. The scheme had been intended to make healthcare more affordable following the demise of co-operative health schemes in the 1980s that left most rural Chinese without any subsidised healthcare.
The NCMS proved to be very popular and with subscriptions costing as little as 10RMB a month it soon covered 97% of rural residents - or about 830 million people.
However, a new analysis of the scheme shows that out-of-pocket costs for treatment have actually increased under the program. It seems that rural hospitals have been using the easier availability of funds from the scheme to raise their prices for services and have not been passing savings on to patients.
An analysis by Chinese health economists working at the LSE in London has found that the average cost of outpatient treatment went up from 205 RMB in 2004 to 308 RMB in 2009. After re-imbursement, patients ended up paying 254 RMB for treatment in 2009 under the new NCMS scheme - almost 50 RMB more than they did without insurance.
The authors of the study say the availability of funds through patients’ NCMS insurance may have caused 'cost inflation' by inducing rural hospitals and doctors to use more expensive drugs and treatments, so as to make more profits for their cash-strapped instiutions.
"Much of the government support intended to subsidise participants’ payments for health care may instead have been absorbed by the insatiable quest for revenues and cost coverage at these smaller health facilities, simply to survive," they write.
Therefore it is not surprising that "the rapid expansion of NCMS through massive injection of government subsidies has so far had limited impacts on either improving access or reducing out-of-pocket payments for outpatient care," they note.
"In fact, our analysis indicates that rural residents covered by NCMS are less likely to seek outpatient care than uninsured residents who did not subscribe to the programme. There is no evidence from our analysis that NCMS has succeeded in reducing out-of-pocket payments for outpatient care," they conclude.
Writing in the journal Health Policy and Planning, the researchers warn that: "further infusions of government subsidies aimed at covering rising NCMS expenditures may simply induce further waves of cost escalation unless NCMS can use its leverage as purchaser and third-party payer to introduce cost-saving measures in participating health services facilities."
China’s New Co-operative Medical Scheme has done the opposite of what it was intended to do: it has increased costs and reduced access to health services for rural people, a study has found.
The government-subsidised health insurance program for rural residents was introduced in 2003 and was designed to reduce out-of-pocket payments for hospital treatment for rural Chinese. The scheme had been intended to make healthcare more affordable following the demise of co-operative health schemes in the 1980s that left most rural Chinese without any subsidised healthcare.
The NCMS proved to be very popular and with subscriptions costing as little as 10RMB a month it soon covered 97% of rural residents - or about 830 million people.
However, a new analysis of the scheme shows that out-of-pocket costs for treatment have actually increased under the program. It seems that rural hospitals have been using the easier availability of funds from the scheme to raise their prices for services and have not been passing savings on to patients.
An analysis by Chinese health economists working at the LSE in London has found that the average cost of outpatient treatment went up from 205 RMB in 2004 to 308 RMB in 2009. After re-imbursement, patients ended up paying 254 RMB for treatment in 2009 under the new NCMS scheme - almost 50 RMB more than they did without insurance.
The authors of the study say the availability of funds through patients’ NCMS insurance may have caused 'cost inflation' by inducing rural hospitals and doctors to use more expensive drugs and treatments, so as to make more profits for their cash-strapped instiutions.
"Much of the government support intended to subsidise participants’ payments for health care may instead have been absorbed by the insatiable quest for revenues and cost coverage at these smaller health facilities, simply to survive," they write.
Therefore it is not surprising that "the rapid expansion of NCMS through massive injection of government subsidies has so far had limited impacts on either improving access or reducing out-of-pocket payments for outpatient care," they note.
"In fact, our analysis indicates that rural residents covered by NCMS are less likely to seek outpatient care than uninsured residents who did not subscribe to the programme. There is no evidence from our analysis that NCMS has succeeded in reducing out-of-pocket payments for outpatient care," they conclude.
Writing in the journal Health Policy and Planning, the researchers warn that: "further infusions of government subsidies aimed at covering rising NCMS expenditures may simply induce further waves of cost escalation unless NCMS can use its leverage as purchaser and third-party payer to introduce cost-saving measures in participating health services facilities."
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