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.

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.

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

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

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

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

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

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.

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

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

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

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

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

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.

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.

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.

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 medical news for Sunday 2 February

Cosmetic procedures a high risk for hepatitis C
Chinese people are more likely to contract hepatitis C from a cosmetic and beauty treatments than from medical procedures or blood transfusion, a study from Jilin shows.
Researchers found that hepatitis C rates had increased rapidly in Yanbian, Jilin, more than doubling from  2007 to 2011. Unexpectedly, they found that cosmetic treatments conferred the higest risk - almost five fold higher than control groups. Having someone esle in the family with HCV was also a high risk for infection, presumably through sexual transmission between spouses, the researchers said. Writing in PLOS One, the researchers for the Capital Medical University, Beijing, said cosmetic treatments had become popular in recent years and there was a risk of viral infection with procedures that broke the skin such as shaving and ear piercing.

Atherosclerosis defined in stroke
Intracranial atherosclerosis (ICAS) is the most common vascular lesion in patients with cerebrovascular disease in China, a study  has shown. Researchers at the Tiantan Hospital in Beijing assessed 2864 consecutive patients who experienced an acute cerebral ischemia and found the prevalence of ICAS was 47%. Patients with ICAS had more severe stroke at admission and stayed longer in hospitals compared with those without intracranial stenosis. According to the study in Stroke, after 12 months, recurrent stroke occurred in 3.3% of patients with no stenosis, in 3.8% for those with 50% to 69% stenosis, in 5.2% for those with 70% to 99% stenosis, and in 7.3% for those with total occlusion.

STI risk high for men who visit prostitutes
Men who have unprotected sex with prostitutes are at high risk of HIV and syphilis, Guangxi research has shown. A study of more than 100 men who visited prostitutes found a high rate of unprotected sex (84%). The overall prevalence of HIV, hepatitis C and syphilis was 1.9%, 1.0% and 18.4%, respectively, according to the study published in Sexually Transmitted Infections.

Parasite problems on the Tibetan plateau
Worm parasites are an endemic problem for Tibetans, especially nomadic herders, a study has found.
Echinococcosis affects more than 380,000 people on the Tibet-Qinghai plateua, is spread by dogs and cattle, and is often picked up from drinking groundwater, according to a study by Chinese researchers. Those most at risk include the old and female in particular. Writing in Infectious Diseases of Poverty, the researchers said control of the parasites should focus on deworming both owned and stray dogs and health education activities n Tibetan language.

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

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

China medical news for Saturday 1 February

Light news day today as most Chinese are no doubt at home enjoying (or enduring) the New Year with family...

Ambulances must not refuse penniless patients
The Global Times reports that ambulance and first-aid teams will be forced to treat patients regardless of whether they can pay. A new regulation on management of emergency medical services was adopted by the National Health and Family Planning Commission which bans emergency services from refusing or delaying treatment because the patients cannot pay. The new rules also prohibit ambulances being used for purposes other than offering emergency medical service.

Indemnity insurance to be mandatory
The Chinese government is also said to be planning a move to make medical indemnity insurance compulsory for all doctors. The head of the China Insurance Regulatory Commission, said one goal this year would be to promote compulsory medical liability insurance, with medical institutions and doctors required to purchase such cover. This would ensure that victims of medical malpractice can be assured of compensation, thus stamping out violence in medical establishments.

Say no to cigs
Health groups in China have urged people not to give cigarettes as gifts this New Year and to refuse them if offered. Groups including the Chinese Center for Disease Control and Prevention and the Chinese Medical Association made the plea just prior to the arrival of the Year of the Horse, according to CRI.

H7N9 explained
In the New Scientist Debra McKenzie explains the background to the H7N9 avian influenza virus outbreaks at a molecular as well as epidemiological level. She also provides some ideas of what the solution to possible pandemics might be.

China's medical news for Friday 31 January

Breast milk contains high levels of DDT
Breastfeeding mothers in Zhejiang have high levels of DDT in their milk, a study has shown. Researchers said the high levels of DDT found in breast milk were in excess of safe limits and showed that human milk was "grossly polluted". The DDT was thoght to come from seafood in the diet, the researchers said in the journal Environment International.

Shanghai obesity myth dispelled
Shanghai researchers have dispelled the concept of 'metabolically healthy obese'. In a study of more than 211,000 people over 40 i 25 areas of China they showed that  obesity was a risk factor for  CHD regardless of the presence or absence of insulin resistance. The findings are published in the International Journal of Cardiology.

Zinc levels linked to naughty children
Low zinc levels have been linked to behavioural problems in pre-school children in China. A study conducted in 1314 children in Jintan, Jiangsu found that low zinc levels were significantly associated with increased reports of total behavior problems. Living in the suburbs was associated with increased internalizing problems, while higher mother’s education and being female were associated with decreased externalizing problems, the study in the journal Nutrients found.

N95 face masks prove effective

A study of the effectiveness of N95 masks in Beijing has found that they are protective against bacterial colonization, co-colonization and viral-bacterial co-infection. The clinical trial of 1441 hospital staff found the rate of bacterial colonization was 2.8% with N95 mask users, 5.3% in medical mask users  and 7.5% in staff who did not wear any mask. Co-infections of bacteria and/or a virus  occurred in up to 3.7% of healthcare workers and were significantly lower in N95 wearers, the study in Preventive Medicine showed. (NB: See our earlier story that found N95 masks were a poor fit for Chinese faces).

Medicine costs and hospitals

The Economist has an article explaining why China's hospitals are dependent on revenue from drug sales for their financial viability. The magazine says efforts to reduce corruption will be difficult until the system is reformed, as hospital derive 40% of income from commissions on medicines and medical products.

China has psychotherapy boom

Mental disorders have traditionally been a taboo subject in China, but SBS reports that a reality television show Psychological Sessions has been captivating audiences across China. And a researcher says there is now a 'psychotherapy-boom' in China as people have become aware of modern-day stresses and the need for treatment. 

Women don't get a fair go in health

Women face medical discrimination in China as they appear to have lower rates of treatment than men, a study suggests. Published in the International Journal for Equity in Health, the study finds that women have lower rates of hospital admission than men for the same conditions. Women also have lower rates of investigations and shorter hospital stays compared to their male equivalents.

Health ministry outlines penalties for doctors who accept bribes or kickbacks

translated by Michael Woodhead
Doctors and healthcare staff who accept bribes or kickbacks may receive anything from a warning to being fired, depending on the severity of the offence, according to draft regulations released this week by the National Health and Family Planing Commission.
The draft rules cover the acceptance by staff of bribes such as 'red envelopes' for preferetial treatment. They also apply to medical staff who accept any free or discounted goods such as drugs, medical devices or equipment from suppliers. The regulations cover activities such as accepting unauthorised commissions, kickbacks or rebates from suppliers.
For any medical personnel found to be accepting bribes or kickbacks the penalties include expulsion from the workplace and loss of licence to practice. Other sanctions include demotion, warnings and 'demerits', the NHFPC plan says.
The draft regulations have been circulated to all local health and family planning work units, to medical institutions, hospitals and medical education units. Feedback will be accepted by the NHFPC until 8 March.

China medical news for Thursday 30 January

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

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

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

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

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

Seven important items of medical research from China

N95 masks don't work for Chinese faces
The specialised N95 face masks used to protect against infections such as influenza are not shaped to fit Chinese faces and most would fail to prevent transmission because of poor fit and leakage, tests by Wuhan researchers have shown. Evaluation tests on ten different types of N95 mask found that only two performed within acceptable limits to prevent transmission of infections. Performance of some masks was better when users were trained and they were specially fitted, the study in PLOS One showed.
"This study indicated that widely used N95 filtering facepiece respirators in China didn't fit well and can't provide desired protection for respirator users," the researchers concluded.

Malaria from Africa now a problem in China
Malaria has been virtually eliminated in China but doctors now face the problem of treating malaria in Chinese workers who have returned from Africa. In Jiangsu there have been 918 malaria cases and six deaths in the last decade due to malaria imported from other countries. The imported cases make up 12% of all malaria cases and account for all malaria deaths, according to researchers from the Jiangsu Institute of Parasitic Diseases, Wuxi, writing in the Malaria Journal.

No cardiovascular treatment for many Chinese patients
Two out of three Chinese people with cardiovascular disease are still going untreated, a major study has found. Data from of 512,891 Chinese adults showed that 5% had a history of cardiovascular disease. However, of these only 35% had been treated with any cardiovascular medicine for secondary prevention such as statins, antiplatelet drugs or antihypertensives. The findings from a team from Oxford and Beijing universities, are published in the International Journal of Cardiology.

Shenzhen women have high rates of HPV
More than one in ten women in Shenzhen are have HPV serotypes that put them at risk of cervical cancer, researchers say. A study of 4, 413 women measured HPV infection rates and the prevalance was 14%. The high risk HPV types 16 and 18 that are likely to cause cervical cancer were found in 3.5% of women and 1.27% of women, according to the study published in the Asia Pacific Journal of Cancer Prevention.

Avian H7N9 flu virus on way to mutation
The H7N9 influenza virus is genetically much more diverse than previously thought, suggesting that it is reassorting and closer to mutating into a pandemic virus, researchers from the Jiangsu Provincial Center for Disease Control and Prevention, have shown. They report their findings in Nature.

Medical teacher burnout
Staff at medical colleges in China have high rates of burnout, a study from Shanxi shows. Staff who had a love of teaching and those who received praise and recognition were less likey to suffere burnout, according to the study in Archives of Environmental & Occupational Health.

Pancreatic cancer in Shanghai
The diagnosis and treatment of pancreatic cancer in Shanghai has room for improvement, according to researchers from Fudan University. In a review of management of pancreatic cancer published in Cancer Letters, they report that most patients miss out on the recommended histologically verified diagnosis and the 1-year and 2-year survival rates were 35% and 14.4%, respectively.

China medical news headlines for Wednesday 29th January

Tuberculosis rates fall by 80%
Rates of tuberculosis in Shandong have fallen by 80% in the last decade, a study of 55,000 adults has shown.The prevalence rate of bacteriologically confirmed TB ases was 34 per 100,000 for adults in 2010. However, diagnosis of TB is now more difficult as half of bacteriologically confirmed cases did not present persistent cough, researchers said in BMC Infectious Diseases.

Man arrested for spreading H7N9 rumours
China's internet is full of stories of doctors and medical staff who have died of H7N9 influenza. Social networks such as Sina Weibo, QQ and WeChat have stories circulated by netizens of deaths of medical staff in Shanghai, Tianjing, Shenzhen and Nantong, according to CRI. However, health authorities have branded the stories as rumours and have arrested one man for spreading false information. In one case, a doctor who was named as having died of H7N9 influenza has startled patients by being on duty at hospital.

Shanghai life expectancy is 82
Life expectancy in Shangahi is 82 and a half years old, the Shanghai Health and Family Planning Commission has said. Women have a life expectancy four and a half years longer than, a report in ECMS said. LIfe expectancy in the city is on a par with developed countries but infant mortality including migrant families, rose from 5.04 per 1,000 in 2013 to 5.73 per 1,000.

High alert as H7N9 cases increase
China has gone on to high alert for H7N9 influenza as the number of cases continues to increase. Bird markets have been shut down in Shanghai and quarantine authorities have stepped up monitoring at airports. However, health authorities have played down the risk of a pandemic, saying the infection is not spread by human-to-human transmission. A vaccine against the H7N9 virus is being developed but is not ready for use in humans yet, authorities have reported.

China's can't cope with dementia
People in China are ill prepared to cope with the huge number of elderly people with dementia and Alzheimers disease, according to an article in SCMP. China has almost six million patients with Alzheimer's, 50% higher than a decade ago and twice as many as earlier estimated by the international health community. However, caring for dementia sufferers in China is left to family members with limited or no training and no support from the state.

Red Cross resuscitation ads are wrong
An advertising campaign by the Red Cross that urges Chinese to help those who have collapsed and need resuscitation is technically inaccurate, according to emergency specialists The picture on the ad shows a woman pressing the soft tissue of the patient's neck, which will lead to obstruction of the airway. First-aid practitioners should place their index finger and middle finger on the patient's chin bone, a doctor has pointed out.

Act early to stop leprosy, Guizhou expert urges

translated by Michael Woodhead
Leprosy is still a problem in some parts of China, but it can be controlled if detected and treated early enough, an infectious diseases expert from Guizhou has said.
Speakin in International Leprosy Action Week, Dr Li Jinlan of the Guizhou Centre for Disease Control and Prevention said leprosy is still present in poor districts parts of southern China where hygiene standards were low. He said leprosy needed warm and humid conditions to thrive, but it could be controlled if the symptoms were detected early and chemotherapy give. According to Guangming Daily, he urged Chinese citizens to remember the 'Three roots' to leprosy.  The first root is awareness of the the possibility of leprosy, especially in people who have a long-lasting rash, skin lumps, white spots and numbness of the skin. The second factor is to have experienced clinics that can recognise and treat leprosy in a timely way. The third root is to be not afraid of seeking diagnosis and treatment due to stigma. Dr Li said leprosy was often transmitted within families and relatives should arrange for anyone they suspect to have leprosy to be checked out.

China medical news headlines for Tuesday 28 January

Hospital care declines after switch to contract nurses
China's hospitals are no longer employing career nurses but opting for cheaper contract nurses, resulting in inferior levels of care, researchers from the School of Nursing, Sun Yat-sen University,  Guangzhou have shown.  Their study found that hospitals are moving away from the 'bianzhi' system of state-guaranteed lifetime employment to a contract-based nurse employment system with limited job security and reduced benefits. This may adversely affect both nurse and patient satisfaction in hospitals, the study found.

Tamiflu call for H7N9 flu
The increasing threat of H7N9 avian influenza has prompted Shanghai to shut down bird markets after 12 deaths in surrounding areas.  Live poultry trading has been banned in nearby Zhejiang cities, after 49 human H7N9 infections and 12 deaths were reported this month, says the Shanghai Daily.  Meanwhile Zhong Nanshan, director of the Guangzhou Institute of Respiratory Diseases has suggested early and longer use of antiviral drug Tamiflu for H7N9 patients.

Death sentence for hospital attack
The man who killed a doctor at a Zhejiang hospital in a medical dispute has been sentenced to death by a Taizhou court.  The 33-year old man stabbed a doctor to death at Wenling hospital and wounded two other doctors because he was unhappy with surgery to cure a nose problem which he said was causing extreme pain, according to the Global Times.

Boy died after drip infusion
Shanghai authorities are investigating how an allergy-prone boy died after having an IV drip infusion treatment for a cold at a local hospital.  The boys parents allege that the hospital has covered up the incident and switched the infusion packaging to prevent analysis of the fluid used, according to ECNS.

China medical news headlines for Monday 27th January

Premier pledges social security system
In his first press conference as premier, Li Keqiang affirmed the Chinese government's commitment to building a social security system safety net that will include provision of medical care. According to China Daily, the premier said the government should "weave a network that guarantees the basic living of all the people", covering education, medical care, social insurance and housing.

Blood donations dry up at New Year
China is facing severe shortages in blood donations as the usual donors - students - return home for Chinese New Year. Nanning's blood donation centre now has only 300 donors a day but the city needs 4-500 to meet hospital demand, according to CRI. Cold winter weather also deters people from going to blood donation centers or donation buses, health authorities say.

Whistleblower doctor gets her job back
Mianyang's 'corridor doctor' whistleblower who lost her job after complaining about hospital overservicing will be offered her job back after an inquiry, authorities in Sichuan say, according to Global Times. Lan Yuefeng worked in a corridor for two years after protesting about her hospital offering unnecessary treatments and profiteering.

Laowai not using medical cards
Foreigners who work in China now receive social security cards that allow them to access subsidised medical treatment in the same way as Chinese citizens, according to China Daily. However many foreigners are unsure of their entitlements and do not use them, a professor says.

Social security shortfall
New social security laws compel local authorities to provide financial assistance to the needy including those with severe medical conditions and local officials  face legal action if they refuse to provide it, according to the Beijing Review. However,  local authorities say they do not have the personnel to check every single claim for validity.

Outdoor workers get pollution clinics
Shanghai has set up special drop-in medical centres for outdoor workers who are suffering from the effects of air pollution, according to ECNS. The city authorities have also provided 300 medical cards for outdoor workers because of their high risk of pollution-related ailments.

Leaders call for action on H7N9 response
The Chinese vice premier Liu Yandong has called on all local authorities across China to take action to prevent the spread of H7N9 influenza. Local health departments will face punishment if they do not take action on epidemic surveillance and outbreak response plans in areas such as health institutions and schools. Poultry markets in Beijing have not tested positive for H7N9 influenza virus, according to the Shanghai Daily. However Shanghai has now experienced its eighth case of H7N9 avian influenza of the year, the paper reports.