Clinical news round-up from China

From the medical journals .... by Michael Woodhead

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

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

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

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

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

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

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

Beijing clinicians find changes in cause of infective endocarditis

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

Chinese police arrest 1300 for illegal online drug sales

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

Baby abducted from Guangdong maternity hospital

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

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

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

Elderly Hunan villagers prefer suicide to living without medical care

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

Beijing private clinic offers Harvard Medical doctors

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

Chinese genomic sequencing company worries Japan with cheap prenatal testing

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

China considers national indoor smoking bans

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

Cold blooded doctor comment angers relatives of dead Jiangxi woman

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

Small hospitals used in cheap medication re-selling scam

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

Hospitals ordered not to refuse HIV patients

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

HPV linked to oesophageal squamous cell carcinoma in China

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

Beijing to provide more hospital beds for elderly

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

Dodgy drug makers will be blacklisted in China

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

Medical staff must study law to fix patient disputes

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

Quarter of a million premature deaths in China due to coal

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

Chinese H7N9 flu virus mutates to become resistant to antivirals

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

Impressions of an American medic on a Chinese hospital ward round

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

Hospital clinicians face infection risk from procedures

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