Friday, 30 November 2012

Immunisation campaign keeps China polio free: WHO

Immunisation curbed 2011 polio outbreak in Xinjiang
A commission under the World Health Organization (WHO) announced in Beijing on Thursday that China has retained its polio-free status, after successfully combating a severe outbreak in 2011.
After more than 10 years of being labeled as a "polio-free" country,China confirmed four cases of wild poliovirus infection in Xinjiang Uygur autonomous region on August 25, 2011.
Upon request, WHO labs later found the poliovirus was imported from neighboring Pakistan, where the disease remains endemic.
The Chinese government promptly launched emergency response plans and a massive vaccination campaign, according to a report issued Thursday at the closing session of the four-day 18th meeting of the WHO Regional Commission for the Certification of Poliomyelitis Eradication.
China's Ministry of Health confirmed that over 43 million people in Xinjiang had been vaccinated.
The last case was reported on October 9, 2011, taking the total count to 21, including two deaths, according to the ministry.
The commission said China had made an "exemplary response" by limiting the outbreak to 1.5 months from laboratory confirmation to onset of latest case and restricting it to four prefectures.
Outbreak investigation and response actions undertaken in China in 2011 serve as models for any other outbreak following importation globally, said the report.
The commission also announced that the Western Pacific Region is retaining its polio-free certification for being free of poliovirus for the past 12 months.
However, it warned that "the status is not a guarantee, shield or curtain," and called for global collaboration in eradicating polio.
Polio-free countries remain at risk until the disease has been eradicated globally, according to Dr Bruce Aylward, assistant director-general for polio, emergencies and country collaboration at the WHO.
Polio is a highly infectious disease that mainly affects children under five years of age. Infections sometimes lead to irreversible paralysis.
Source: China Daily

Western medical device companies seek expansion in China

Medical equipment companies such as Medtronic have invested heavily in China
Foreign investors are targeting China's ageing population as Western medical companies dash to fill the nation's demand for medical devices geared for China's 181 million senior citizens.
Moving to tap into the potential market for medical devices aimed at treating seniors, US-based medical companies are investing millions into easing the aches and pains of old age.
In September, Medtronic, a Minneapolis-based medical device maker paid $755 million (584 million euros) for Kanghui Holdings Inc, one of China's top three manufacturers of spinal support and artificial joints.
"The integration of Kanghui provides Medtronic a strong position in China's rapidly expanding orthopedics segment, as well as a high potential platform for the development of a global value segment in orthopedics," said Chris O'Connell, executive vice-president and president of Medtronic's Restorative Therapies Group, in early November.
The takeover is the largest overseas acquisition the medical device maker has made as it targets growth in China's less competitive second and third-tier cities.
With sales of orthopedic devices in China expected to increase to more than $2.7 billion by 2015, the move indicates how important China's senior market is for Western companies.
Medtronics is just the latest in a string of US-based medical device companies investing to expand in China's commercial realm.
Last year, Boston Scientific, one of the US' largest device-making companies, pledged to invest more than $115 million in expanding its commercial presence in China.
In late October, BG Medicine, a US producer of cardiac diagnostic tests, formed a partnership with Kindstar Diagnostics Co Ltd, the largest esoteric diagnostic testing company in China.
The move will grant BG Medicine access to more than 2,000 hospitals throughout China.
The increased focus by Western medical companies on the China market suggests that as China's economy continues to expand, so does the desire to offer world-class medical treatment.
For foreign investors looking to establish high-acuity medical care centers for seniors, having access to the latest in medical devices and procedures can mean the difference between success or failure.
"Foreign investors that have their strength in senior care expertise know how to design, build and operate senior care facilities," says Qu Qun, a lawyer with Shanghai Co-Effort Law Firm and editor of China Senior Housing and Care Newsletter.
"One of their biggest strengths compared with the domestic competition is their access to first-class technology used in senior care facilities and in-home care services."
Qu estimates that the senior housing and care market will be worth 1.8 trillion yuan ($290 billion; 220 billion euros) a year by 2020 and 7.6 trillion by 2050 and that the money spent on devices geared toward assisting the ailing elderly is only beginning to grow.
And as investors begin to renew their efforts to establish businesses in China, the timing for foreign medical device makers expansion could not be better.
"There is no reason they shouldn't come and invest here," Qu says.

US investment banker brings medical-assisted aged care homes to China

 Cascade aims to combine Western elements with Chinese-style assisted living
Chris Alberti is all too familiar with the agony of a child faced with making tough decisions about a parent's medical future.
When his father suffered blood circulation problems in 2006, doctors had to amputate part of his father's left foot, a decision that meant he would require expert medical attention daily.
It was a trying time for Alberti and his family, who had to tackle the tough decision of whether or not to put their father in an assisted-living facility.
But the decision also spurred the 59-year-old Boston native to make a dramatic change in his own life, shifting from the number-filled world of government finance and investment banking to helping set up what he says is one of the most comprehensive assisted-care facilities in China.
"It was one of the major drivers for why I'm now doing what I'm doing," he says.
Alberti is director and one of the founders of Cascade Healthcare, or Kai Jian in Mandarin, a joint venture with US senior care giant Emeritus and one of the largest foreign players pushing to get involved in China's senior assisted-living sector.
Cascade's first assisted-living facility opened in Shanghai's Xuhui district in mid-October, and is one of more than a dozen set to open in China in the near future.
After having seen his father go in and out of assisted-living centers that provided healthcare but did little to offer residents a good quality of life, Alberti began drafting plans to bring world-class elderly care facilities to China's booming population of seniors.
While this may not be the first attempt at establishing senior housing in China, he says it is the first of its kind to fuse retirement living with high-standard medical assistance.
By focusing on the service side of assisted living, he says they are producing a business model that has not yet been tried in China.
Despite the recent easing of restrictions allowing wholly-owned foreign enterprises to compete in China's senior-health sector, Cascade is opting for a joint-venture, working with domestic companies like real-estate giant Sino-Ocean as they plan to establish more than a dozen care centers in Beijing and beyond.
Alberti says they made the decision to enter into a joint venture in order to ensure that their product offers a genuine local touch.
"When you're dealing with issues that are closest to home to Chinese people such as taking care of your parents, you want the benefits and clarity that a local partner can bring to an enterprise," he says.
"We're not bringing a foreign company to China. We're creating a Chinese company affiliated with foreign companies, but with a design toward creating a great Chinese brand."
Describing their newest facility as "Western with Chinese characteristics", Cascade's newly opened Shanghai facility has adjusted for the Chinese market by incorporating local designs and elements of traditional Chinese medicine.
But he says it's also important to keep Western elements, specifically in the realm of care, to help distinguish Cascade from local competition and continue to learn about this uncharted dimension of China's health industry.
"If we do a good job here, there's an enormous market and we'll all do well and maybe, just maybe, we can make a difference in China."
Read more: China Daily

UK tabloid highlights Li Keqiang's role in illegal blood donation cover-up

Daily Mail says Li Keqiang covered up illegal blood donation scandal that saw thousands of Chinese infected with HIV
 Britain's Daily Mail newspaper today blames China's new prime minister Li Keqiang for covering up  tens of thousands of HIV infections from illegal blood donations in Henan.
In what the newspaper describes as "one of the biggest medical scandals of all time" it says 50,000 to 300,000 people were mistakenly infected with HIV in Henan province in the 1990s and China's new PM, Li Keqiang, was the man who led the cover-up.
Mr Li was governor of the area in 1998 when people contracted HIV from state-sponsored blood-buying rings with unhygienic practices.
The Mail says activists have urged Li to acknowledge the government's responsibility for the disaster and provide compensation, with little success.
There are no official figures because the Chinese government has never admitted or apologised for what happened but now Mr Li is desperately trying to rectify his shadowy past.
Earlier this week Li shook hands with Aids victims on Chinese television and promised to let NGOs play a more active role in battling the disease.
The stigma against people with HIV runs especially deep in China, from being unofficially barred from government jobs to being expelled from school.
In China, hospitals routinely reject people with HIV for surgery out of fear of exposure to the virus or harm to their reputations.
But last Friday, following Mr Li's orders, the health ministry banned hospitals from turning away infected patients.
During a meeting Monday with a dozen activist groups, he said such discrimination would be severely punished, according to Li Hu.
After years of denying AIDS was a problem in China, the country has significantly improved care for patients, but the lingering stigma sets back those advances.
Read more: Daily Mail

Vaccine adverse reaction no higher in China than other countries

by Michael Woodhead
A review of vaccine-related adverse effects in China has found hat rates are in line with those seen in other countries.
Researchers from the National Immunisation Program, Chinese Centre of Disease Control and Prevention, Beijing, found that overall rates of adverse events following immunisation (AEFI)  in China were in line with other health systems, though there was considerable regional variation. Rates of adverse events ranged from 2.3–38/100,000 doses.
As in other countries, the highest rates of adverse events were seen after immunisation with diphtheria–tetanus–pertussis (whole-cell) vaccine  and DTP (acellular) (DTaP) vaccines. Lower rates of adverse events were seen for vaccines against hepatitis B virus, poliovirus, and Japanese encephalitis virus.
"Overall adverse events following immunisation  reporting rates in China were consistent with similar post-marketing surveillance systems in other countries. Sources of regional heterogeneity in AEFI reporting rates and their relationships to differing vaccine manufacturers versus differing surveillance practices, and safety of key vaccines suggested higher reporting rates require further exploration," the researchers conclude.
Read more: Vaccine.

Suicidality more common in Chinese women

 by Michael Woodhead
Women are more likely to attempt suicide than men, a study carried out in the emergency departments of Shenyang has found.
A review of 239 patients who were treated at a Shenyang hospital fro attempted suicide found that 22% were men, and 78% were women.
Men were more likely to be drug users, more likely to be icing with family and less likely to be living alone or co-habitating. Women were more likely to express suicide ideation compared with men. About 70% of both men and women who attempted suicide had   had mental illness.
The unique, gender-specific characteristics pertaining to suicide attempters in urban China emphasizes the need for gender-specific interventions in future clinical treatment.
Read more: General Hospital Psychiatry

Flawed PSA screening means Chinese men have unnecessary surgery

Many Chinese men have unnecessary prostate biopsies because the PSA screening test cutoff of 4ng/ml is too low
by Michael Woodhead
The first major study to evaluate PSA screening for prostate cancer in a China has found that  the currently-used PSA screening test cutoffs are far too low and will lead to overdiagnosis and over treatment.
Doctors at the Department of Urology of Huashan Hospital, Fudan University in Shanghai, reviewed data from 1,650 men who underwent prostate biopsy for prostate cancer at the hospital from 2003–2011
They found that the overall rate of positive biopsy (47%) was much higher than that seen in western countries (less than 35%), but the positive biopsy rate had fallen gradually over the last ten years.
"This may be due to the fact that PSA testing was not popular in China in earlier years and patients were more likely to be biopsied because they were experiencing other symptoms (e.g. hematuria, dysuria). Therefore, they observed higher detection rates of prostate cancer and dropped thereafter due to widespread use of PSA test," the researchers say.
However, their study also showed that the current benchmark PSA level of 4ng/ml for suspicion of prostate cancer - as used in western countries, was inappropriate for the Chinese population.
Only 5% of men with a total PSA level of 4 ng/mL were diagnosed with prostate cancer, much lower than rates in western countries. Even men with a PSA level of 10 ng/mL had lower risk (15%) than men studied in western studies. The tPSA levels at diagnosis for Chinese men were much higher than levels for men in western countries. The tPSA level at diagnosis fluctuated from 28.6 ng/mL to 50.9 ng/mL (median), while in western trials the median ranged from 11.8 ng/mL to 6.3 ng/L.
"Using a cutoff value of 4 ng/mL for prostate biopsy will cause a large number of men to undergo unnecessary prostate biopsies. Thus, we believe that using a cutoff value of total PSA of greater than 4 ng/mL for prostate biopsy in China is not appropriate," they conclude
"We suggest that when using a PSA of over 4 ng/mL as cutoff value for prostate biopsy, fPSA/tPSA, PSAD or other clinical information should be comprehensively considered before a new cutoff value is set up based on further prospective and larger population studies," they add.
Read more: PLOS One

Tuberculosis still deadly for Chinese infants

Extra-pulmonary TB is more severe and life threatening, especially in infants
by Michael Woodhead
A study of the impact of childhood tuberculosis (TB) in China has found it is most severe in young infants, many of whom still die from the infection.
Researchers assessed the outcomes of children with TB treated at one of China's main referral centres for paediatric tuberculosis, the Beijing Children's Hospital.
The review of the cases of 1212 children admitted to the hospital for the treatment of TB from 2002 to 2010. found that 54%  had extrapulmonary tuberculosis (EPTB), 39% had tuberculous meningitis, and 31% had disseminated TB. The last two types were defined as severe TB. Most patients with TB (82%) were cured or completed treatment.
However, there were more children aged under five and from rural areas with extrapulmonary tuberculosis than with pulmonary tuberculosis. More severe cases of TB were found in children under one year of age, and infants and those with severe TB were also more likely to have poor treatment outcomes (failed to improve or died).Patients with no BCG vaccination and a contact history at home had a significantly risk of contracting severe TB.
 Among those with extrapulmonary tuberculosis, only 61% had positive results with either tuberculin skin tests or chest X-rays.
The researchers conclude that "patients with no BCG vaccination and contact history at home might have a higher risk of contracting severe TB. Thus, prevention
and health care in paediatric TB should focus on both extrapulmonary tuberculosis  and severe TB, and patients aged under one year of age should be treated with special care."
Read more: Pediatrics

Hunan transplant surgeon jailed in iPhone-for-kidney case

Surgeon Song Zhongyu, who carried out an illegal kidney transplant operation, was sentenced to three years
China has jailed seven people including a surgeon over the case of a teenager from one of the country's poorest areas who sold his kidney and bought an iPhone and an iPad 2, state media reports.
High school student Wang Shangkun, 18, suffered renal failure after receiving an illegal transplant operation in April last year, Xinhua news agency said.
He had agreed to sell one of his kidneys after meeting the gang through an online chatroom and received 22,000 yuan ($3350) for the organ, although it was sold on for almost 10 times that amount.
A total of nine defendants were found guilty of intentional injury, although two did not face punishment because of their minor roles in the crime, Xinhua said.
He Wei, who organised the illegal transplant, was sentenced to five years' jail on Thursday.
Surgeon Song Zhongyu, who carried out the operation, was sentenced to three years with a reprieve of five years, the agency said.
He and Song both received more than 50,000 yuan each through the transplant.
Wang's mother, Ou Linchun, had previously told Beihu district people's court in the city of Chenzhou, Hunan province, that her son did not sell his kidney specifically to purchase the Apple devices.
"My son was tempted by the illegal organ traders and might have been afraid of getting caught with such a large amount of money, so he bought a cell phone and a tablet PC," she said, according to local media reports.
The defendants, who did not check Wang's age before the operation, paid him compensation worth more than 1.47 million yuan, Xinhua reported, which added to the court's leniency in sentencing.
Authorities said in August that Chinese police had arrested 137 people, among them doctors, suspected of trafficking human organs in a nationwide crime ring that profited from the huge demand for transplants in China.
Read more: SMH

AIDS-related deaths up by 9% in China

The number of new cases of HIV in China has increased by almost 13% this year

China's health authority announced on Wednesday that 17,740 AIDS-related deaths were reported in the country from January to October, a year-on-year increase of 8.6 percent.
As those living with HIV have become AIDS patients over time,AIDS-related deaths are on the rise, according to the Ministry of Health (MOH).
The MOH said the latest figures show that 34,157 new cases of AIDS were reported in China in the ten-month period, up by 12.7 percent year-on-year.
HIV rates have risen among people aged 15 to 24 and those over 50.
From January to October, 16,131 new cases of HIV infections among citizens over 50 were reported, marking a year-on-year increase of 20.2 percent.
There were also 9,514 new cases of HIV reported among young people aged 15 to 24, up 12.8 percent year on year, according to figures from the MOH.
The MOH said the HIV/AIDS epidemic is rampant in some locations and among certain groups of people.
In total, China reported 492,191 cases of HIV/AIDS by the end of October, including 68,802 new cases this year, according to the MOH.
Sexual transmission has become the primary channel of HIV/AIDS spreading. Sex between men registered a sharp increase, said the MOH.
Out of the new cases of HIV within the ten month period, 84.9 percent contracted the virus through sexual intercourse.
According to China's AIDS Action Plan for the 12th Five-Year Program period (2011-2015) published by the State Council, or China's Cabinet, in February, the country aims to decrease AIDS fatalities by 30 percent by 2015, and new cases by 25 percent as compared to 2010.
Since the end of 2003, the Chinese government has carried out the policy "four frees, one care" for people living with HIV/AIDS. This includes free blood tests for those with HIV, free education for orphans of AIDS patients, free consultation and screening tests, and free antiretroviral therapy for pregnant women.
Read more: Eastday

Shenzhen hospital boss on trial for accepting bribes

A former president of a hospital in Shenzhen, in South China's Guangdong province, stood trial on charges of accepting bribes from bidders.
Zhang Deren, president of Nanshan Hospital from 2007 to 2011, is accused of accepting bribes of HK$100,000 ($12,900) and 700,000 yuan ($112,000) from two companies bidding to provide medical equipment to the hospital in 2007 and 2008. The hospital bought two X-ray machines from the companies. The trial is continuing.

Read more: People's Daily

Eli Lilly has hopes and fears about China expansion

Chairman John Lechleiter says Lilly wants to expand in China but fears its drugs will be copied
 by Laurie Burkitt
Drug company Eli Lilly aims to expand across China amid a rise of chronic illnesses that would propel sales of the pharmaceutical giant's diabetes, cancer and cardiac drugs, its chairman and chief executive said.
But the Indianapolis-based company, along with other industry competitors, faces an uphill challenge in the world's second largest economy, said John Lechleiter in an interview. Mr. Lechleiter, who declined to disclose any specific benchmark goals or plans for expansion in China, said obstacles to growth include slow regulatory approvals for clinical trials, even slower clearance for drug approvals and inefficient protection of intellectual-property rights.
Many drug makers have looked to China as a market with high growth potential and one that could help offset sluggish sales from patent expirations. More than 260 million of the country's citizens suffer from a chronic disease, according to data from China's Ministry of Health. And after a three-year, $125 billion health-care overhaul, insurance coverage has been expanded to 95% of the population, creating more access to health care.
The growth is already evident. For drug makers such as such as Bayer HealthCare and Novo Nordisk China ranks among their top three markets by revenue contribution. Other companies expect China to become a larger part of their business, as China's health-care spending is poised to triple to $1 trillion by 2020, according to consulting firm McKinsey & Co.
Lilly executives, building their diabetes business in the market, have said revenue from China jumped 31% in 2011. The company doesn't break out financial data by country.
Yet challenges exist. Mr. Lechleiter said data protection is a major concern for Lilly, as the company's products are often copied before regulators check to see whether drug patents have expired. "We've seen a lot of progress made in the last three years in China, but more needs to be made if China is to move to build a truly innovative biotechnology industry," said Mr. Lechleiter.
Getting new drugs to market in China is a battle, as drug approval takes eight years on average in the country, said Mr. Lechleiter, adding that China's State Food and Drug Administration lacks adequate manpower to manage requests.
Lilly aims to develop drugs for the Chinese, to help treat diseases prevalent in the country, but regulatory approval for clinical trials takes 12 to 18 months, compared with several weeks in the U.S., Mr. Lechleiter said.
Still, the number of clinical trials Lilly has conducted in China has increased to 16 in 2012, up from nine a year earlier. In 2013, the company plans to have 32. Studies have or will include trials for insulin products and Lilly's erectile dysfunction drug Cialis, the company said.
Chinese health officials are aware of problems in the overall health-care industry, which go far beyond the pharmaceutical market. Many have called for hospital reform, as urban public hospitals are flooded by patients coming from the countryside in hopes of better care than what can be provided in lagging facilities back home.
Despite market problems, Mr. Lechleiter and other Lilly executives remain hopeful."This will soon be the second-largest pharmaceutical market in the world, 95% of the population has basic health-insurance coverage and chronic disease here mirrors developed countries," said Mr. Lechleiter, adding, "There is no other place in the world like China."
Lilly is aiming to increase its market share in pharmaceutical sales, which currently stands at 0.7%, with an estimate of $300 million in sales in the first half of this year, up nearly 17% from the same period a year earlier, according to IMS Health, which tracks drug sales. Increasing sales would mean branching beyond China's biggest cities and into the hinterland, where hospitals and clinics are expanding, but where doctors require additional education, said Eric Baclet, president and general manager of Lilly China.
Building volume is critical for all drug makers in China, which have faced pressure as the government-enforced price restrictions in recent years have increasingly squeezed pharmaceutical companies' profits. Leaders established in 2009 a so-called essential drugs list to phase out premium pricing and offer subsidies on 307 types of drugs.
Messrs. Baclet and Lechleiter didn't address goals for getting Lilly's drugs on the government list.
"The challenge now is to figure out how to cast the net more broadly and to do it efficiently and effectively," Mr. Baclet said.
Read more: WSJ

Five diagnosed with scrub typhus in Nanjing

Scrub typhus is caused by the chigger  mite found in southern China
 Five people in Nanjing in East China's Jiangsu province have been diagnosed with scrub typhus, a disease that killed two females in Guangzhou this year.
Four patients were treated at Zhongda Hospital Affiliated to Southeast University. Wang Xihua, deputy director of the hospital's department of respiratory diseases, said scrub typhus is a type of acute infectious disease caused by the chigger, a tiny mite usually found in Southern China, including Guangdong and Yunnan provinces.
Doctors suggest that people protect themselves when taking part in outdoor activities by wearing long-sleeved clothing and by avoiding sitting on the ground.
Read more: China Daily

Thursday, 29 November 2012

Death highlights need for emergency department database

A real time database would allow patients to be allocated to the nearest emergency department with available beds
by Li Dong
Recently, a patient died after being transferred five times during an emergency rescue in Beijing. 
The incident triggered discussion on what we should do to enhance the efficiency of the current medical emergency rescue system and avoid such things from happening again.  Feng Shilan a 66-year-old woman had chronic leukemia. She fainted in the evening of November 18 and her family called the emergency rescue center.
An ambulance came soon, but she still died after being transferred to five hospitals. Li Zhigang, Feng's son recalls the story.
"The first hospital was the 263 Hospital, then, the Civil Aviation General Hospital. They both say they are not specialized hospitals and don't have the facilities to treat my mom's illness. They recommended that we go to go to the Military General Hospital. But doctors there said their emergency rescue rooms were already packed. Then we went to the Dongzhimen Hospital of Chinese Medicine. They said they don't have rooms. In the end, the ambulance took us to Xiehe Hospital. But doctors at Xiehe Hospital also said they don't have space. That's the last option we tried and my mom died there."
Li was very upset about his mom's death and really wonders why his mom was transferred five times and still died.
"I really don't know why we can't find even one hospital to save my mom's life. It's too complicated to understand. I don't dare imagine. If my mom was treated properly on time, she would not have died."
This incident triggered heated discussion on whether a transparent platform should be established where emergency centers and patients can see what available medical resources are available and where the best hospital is to send a patient. It could save precious time and lives.
One of the reasons frequently mentioned in the incident is the hospitals don't have enough beds. It is true. Statistics show that all the beds in all the top level hospitals across the country have been fully occupied for the past five years.
According to health authorities, there is an emergency rescue information network which began building two years ago but has not been completed.
Huang Chun, director of the Emergency Rescue Administration Office of the Beijing Medical Bureau, says Feng's tragedy will speed up the building of the system.
"I think the system can be in trial operation by 2013. Hopefully the system can be in full operation in 2014."
Some doctors also say efforts should be made to train doctors at lower-level hospitals to improve their ability to treat emergencies.
Read more: CRI

Astrazeneca's antithrombotic drug Brilinta approved in China

AstraZeneca has won approval for its antithrombotic drug ticagrelor (Brilinta) in China, an increasingly important market for the British pharmaceuticals group.
Ticagrelor is a platelet aggregation inhibitor that is indicated for the prevention of thrombotic events (for example stroke or heart attack) in patients with acute coronary syndrome or myocardial infarction with ST elevation.
China's State Food and Drug Administration has issued an drug import licence for the product, meaning it will now be available for treating patients with acute coronary syndrome in the country, the company said on Thursday.
Brilinta has proved better than the cheaper generic medicine clopidogrel in preventing the recurrence of heart attacks, but its sales to date in markets around the world have been disappointing.
Revitalising the product is an early priority for new Chief Executive Pascal Soriot, who said last month that Brilinta could do "far better".
Read more: Yahoo

Fighting for the right to die in China

A 'Choice and Dignity' in death movement has the support of doctors in China
by Zhang Fang
Luo Diandian didn’t realize it was a big deal to start a “no tubes at your last moment” club until she personally made a life-or-death decision for her family member a few years ago, China Youth Daily reported.
Luo’s mother-in-law was hospitalized for diabetes, but suddenly suffered a cardiac arrest after choking on sputum. Doctors put her on respirators, which could not treat her condition but only prolong her life. Finally, Luo and her family made a difficult decision to take her off life support and let her go.
After a few months, Luo found a note from her mother-in-law’s diary, which said that she did not wish to be excessively resuscitated if her death was imminent. Luo felt a big relief, realizing that she made the right choice.
A former doctor, Luo and her friends built an informal club based on that simple idea.
With modern medical technology, a person’s time of death often occurs shortly after the point when life support equipment is shut down. Luo said she believes that patients should have right to decide how to die. But she had no idea that she would eventually make career out of fighting for her beliefs.
After her mother-in-law passed away, she found an end-of-life document from the U.S. called “Five Wishes”, which allows people to write down a living will about their personal, emotional and spiritual needs as well as their medical wishes. Currently, more than four million Americans use this legal document.
“If people sign a document like this, their family would know their final wishes.” Luo said. “It’s a really big deal to give a person the right to die.”
In 2006, Luo decided to set up a formal website called “Choice and Dignity”, which promotes a dignified end to life. The site allows people to write down a living will when they are still consciously able. Since its inception, the site has garnered 870,000 page views.
People can tell their family the way they want to leave the world, including specifying whether or not they want life support, Luo said.
In addition to elderly patients, China’s medical community has taken notice of Luo’s passionate views.
“What Luo Diandian is doing is really important in China,” said Dr. Liu Ruiqi, vice sectary of Chinese Anti-Cancer Association and former Oncology director of the Military General Hospital of Beijing.
After more than 40 years as a doctor, Liu has experienced more than 2,000 death cases and heard many sad stories from his patients. He said he doesn’t agree that patients should spend their last minutes on chemotherapy or in the Intensive Care Unit (ICU). Sometimes, he tells his patients in terminal stages of cancer to buy a ticket and travel around the world rather than get useless treatments. These opinions, however, rarely get support from his peers or patients’ families, he said.
Liu said the ICU is the last place he wants to go in a hospital, though it has the most advanced equipments. He said he doesn’t know whether patients in the ICU are “people or just experimental animals.”
Most people spend 75 percent of the medical expenses on treatments which occur shortly before their death, the China Youth Daily report said. China’s traditional concept of filial duty, instead of doctors’ suggestions, often leads family members to press for continuation of chemotherapy treatments or extensive ICU stays.
Xu, one such family member, decided to pursue aggressive treatment for his father’s lung cancer. He spent hundreds of thousands of yuan to pay for his father’s treatment, but has no regret.
“If you can barely live, how can you talk about dignity? Dignity is supposed to help you live better, not to die,” Xu said. He said he believes that stopping treatment is “not the grounds of morality.”Xu said he disagrees with Chen Zuobing, a doctor who decided to give his 78 year old-father no treatment for late-stage cancer.
Chen, a doctor in the First Affiliated Hospital of Zhejiang University Medical School, said his father’s final days were peaceful and happy. His father went back to his hometown directly from the hospital, said goodbye to every family member, had last Spring Festival with his family, and took a family portrait before he died.
When Chen’s story was featured on a TV show, he received much criticism ― even hateful responses ― from viewers. Chen said he still believes the move was the right choice. Also appearing on the show, Luo fully supported Chen’s decision and almost got into a fight with the opposition side.
Indeed, Luo has run into her own problems while promoting her “die with dignity” philosophy. In China, people don’t like to talk about death most of the time, not to mention choosing to give up on treatment.
Undaunted, Luo said she will continue anyway, and will donate all her organs at the end of her life. She will be happy to see her skeleton hanging in a doctor’s office, she said.
Read more: China Youth Daily

Doctor killed in axe attack at Tianjin hospital

A female doctor was killed at the hospital affiliated to the Tianjin University of Traditional Chinese Medicine
 A female doctor was axed to death by a man in a hospital in North China's Tianjin municipality on Thursday, police sources have confirmed.
Kang Hongqian was attacked and killed at around 1:30 pm by the axe-wielding man in her clinic on the second floor of the No 1 Hospital, which is affiliated to the Tianjin University of Traditional Chinese Medicine, sources said.
Kang, who was on duty at the time of the incident, was a chief doctor with the department of acupuncture at the hospital.
The attacker, whose identity is not known, jumped out of the building after the attack and wounded himself.
He is now under police custody.
The scene has been cordoned off by police, who are investigating the cause of the attack.
Read more: China Daily

Gap to widen between treatment costs and insurance cover

The gap between medical treatment costs and insurance cover is expected to grow
 The funding gap of China's medical insurance is expected to reach 75.87 billion yuan ($12.2 billion) in 2014, it was reported on Thursday.
A medical security gap refers to the disparity between the costs that meet people's demand for healthcare and the funds that can be used to pay the costs, when the proportion of total social medical care expenditure to GDP remains constant.
The medical security gap in the Asia-Pacific region may grow to $197 billion by 2020, according to a newly published report by Swiss Reinsurance.
The report studies 13 countries and regions in the Asia-Pacific region, including China India, Japan, Indonesia, Thailand and Malaysia.
China ranks the first in the medical security gap among the 13 countries, with a $12.2 billion shortage by 2014 and $73 billion by 2020.
A medical security gap refers to the disparity between the costs that meet people's demand for healthcare and the funds that can be used to pay the costs, when the proportion of total social medical care expenditure to GDP remains constant.
China, India Japan and South Korea will have the largest medical security gap before 2020. The medical care cost in the Asia-Pacific region will increase to 2.7 trillion yuan in 2020 from 1.2 trillion yuan in 2010, the report said.
With economic growth and rising family incomes in the region, healthcare expenditure will definitely increase, Huang Shuohui, an official from Swiss Reinsurance said.
Read more: China Daily

Social network site aims to link doctors with drug companies

Baitianshi will link Chinese doctors to drug companies and suppliers
 Japanese venture capital CyberAgent Ventures has announced that it is putting funds into Baitianshi, a social network that connects doctors and pharmaceutical companies in China.
As with many deals from CyberAgent, the level of investment and stake being purchased has been left unannounced.
Baitianshi was founded in December 2010 and it is a real-name social network (online aliases are very often anonymous or characterized in China/Asia) which allows doctors to improve their communication with pharmaceutical suppliers and firms.
The company says it has struck partnerships with “major general hospitals in China” and that, to date, more than 200,000 doctors have used the site. The addition of capital from CyberAgent will see Baitianshi take advantage of the VC firm’s “wide range of resources throughout Asia”.
Read more: TheNextWeb

Chengdu researchers show oral insulin as effective as injected insulin

An enteric coated form of insulin was as effective as NPH insulin when given orally
by Michael Woodhead

While insulin is usually given as an injection because it is broken down and inactivated in the stomach, doctors in Sichuan  have shown that it can be effective when given orally in a special enteral formulation.
Researchers from the Department of Endocrinology and Metabolism at West China Hospital, Sichuan University, Chengdu, evaluated the pharmacodynamic and pharmacokinetic profiles of orally administered enteric insulin and compare the time–action of the oral insulin capsules with a standard insulin injection formulation, neutral protamine Hagedorn (NPH) insulin.
in their study, 12 healthy volunteers received one of three doses of oral enteric insulin (50, 100, or 200 U) or one subcutaneous injection of NPH insulin (6 U) on four separate days.
Glucose infusion rates increased after administration of either NPH or oral enteric insulin. The mean times for maximal metabolic effects for 50, 100, and 200 U of oral enteric insulin were 250, 170, and 236 minutes, respectively, compared with 243 minutes for NPH insulin. The onset of action was slower for oral enteric insulin at 50 U, 100 U  and 200 U compared with NPH insulin. The maximum glucose infusion rates for oral enteric insulin treatment were lower compared with NPH insulin, although these differences were not significant.
The researchers conclude that "oral enteric insulin capsules induced significant glucodynamic effects and exhibited a time–action profile similar to that of NPH insulin in these healthy volunteers. No detectable increases in serum insulin concentration were observed in any treatment group."
Read more: Clinical Therapeutics

News in brief ...

The Ministry of Health has limited power to implement health system reforms in the provinces

Provincial leaders may block China's health reforms

by Michael Woodhead
The second phase of China's health reforms being pushed by the State Council may stall because the real reforms must be made at local level where the Ministry of Health has little sway, a new report claims.
The report by health analysts and economists notes that China's social sectors are heavily decentralised and the Ministry of Health has limited influence on the detailed design and implementation of the health service reforms at provincial level.
The report says provincial leaders in China are mostly driven by economic progress and revenue generation; whereas health is generally regarded as consuming, not generating revenue.
The analysts say a new health management information system and performance-based management of health staff may enhance oversight
"However, parallel reforms in governance, financing, and accountability are also needed in China, to ensure achievement of the equity objective of its health service reforms, "they conclude.
"Pursuing health service reform in China has the potential to improve equity by bringing standardised primary care and public health to those whose health status implies they need it most. However, it will only succeed if sub-national governments are accountable for related public resource allocation, and if vertical monitoring of the quality, equity, efficiency, and effectiveness of the health sector is improved. In addition to HSR, reforms are also needed to align the responsibilities, capacity, and monitoring of all sub-national authorities with health-related national policies, standards, and regulations, and to improve their accountability to the population. These additions go beyond the influence of the Ministry of Health, but accord with the evident priority assigned to health service reform by multiple national authorities, the benefits to other sectors, and the increasing focus of the state on evaluating local government's commitment to public welfare. "
Read more: PLOS Medicine

Hepatitis B the most common infection in Chinese donor blood

Hepatitis B virus infection is the primary threat to blood safety in China, but the increasing prevalence of syphilis might also be a potential threat, researchers say
Researchers from the  School of Public Health at the Fourth Military Medical University,  Xi’an, analysed trends in the prevalence of transfusion-transmissible infectious pathogens among Chinese, first-time, voluntary blood donors from 1999 to 2009 to evaluate the potential for disease transmission.
Blood donations from 263 000 first-time blood donors were analysed. The overall prevalence rates of infection were 1.16% for hepatitis B, 0.5% for HCV, 0.02% for HIV, and 0.3% for syphilis. There was a significant decrease in the trend for hepatitis B and hepatitis C infections, while a significant increase was found for syphilis. The prevalence of HIV infection remained low and stable during the study period.
Read more: International Journal of Infectious Diseases

Asthma in China: less common but less well controlled 

Asthma is less common in China than in the west, but it is poorly controlled where it does exist, a study from provincial Jinan has suggested.
A survey of more than 13,400 people in urban and rural areas of Jinan found that the prevalence of asthma was 1.1%. A history of allergies, asthma family history, household size, and age were independent factors related to asthma.
Dr Wang Dexiang and colleagues fro the Department of Respiratory Medicine, Qilu Hospital, Shandong University, also found that among patients with asthma, control of the condition was poor in a high proportion of patients and even worse in those living in rural areas.
"The asthma prevalence for all ages in Jinan was relatively low compared with that in western countries, however, local asthma control fell markedly short from the goals of GINA (Global Initiative for Asthma) criteria for asthma management, which may be attributed to the poor adherence to GINA guidelines, especially the underuse of preventative medication of inhaled corticosteroids," the researchers say.
Read more: Respirology

Rural migrants get substandard antenatal care in Shanghai

Many migrant women in Shanghai do not receive adequate antenatal care  a new study shows.
Researchers from the School of Public Health at Fudan University interviewed 767 migrant women who had been living in Shanghai for more than six months and who had a baby in hospital there. They foun d that only half had adequately utilised antenatal care (i.e., made five or more antenatal care visits), although 90% made at least one antenatal care visit. Only 20% of migrant women visited an antenatal care centre during the first trimester (12 weeks).
Antenatal care was used most by older migrant women and migrant women whose husbands held Shanghai residency status. Women from high-income households were also more likely to receive antenatal care during the first 12 weeks.
The researchers say that improving utilisation of antenatal care is a critical strategy for achieving China's Millennium Development Goal of decreasing the maternal mortality ratio.
"While overall utilisation has increased recently in China, an urban vs. rural disparity in access remains," they note.
They suggest that more tailored health education is needed for migrant women and their husbands to improve maternal health. Financial support should also be e provided to improve the utilisation of antenatal care, they add.
Read more: BMC Public Health

Sex imbalance gives Chinese men the blues

The skewed sex ratios in China contribute to depression, especially in unmarried men
by Michael Woodhead
The highly unbalanced sex ratios in parts of China are contributing to depression and suicidal tendencies in men, and women, but especially unmarried men, new research shows.
Dr Zhou Xudong and colleagues at the School of Public Health, Zhejiang University, Hangzhou, looked at depression rates in  7435 men and women aged 19–40 in Zhejiang, Yunnan and Guizhou. Depression was measured using the Chinese version of the Beck Depression Inventory (BDI).
They found depression in 17.6% of men and 17% of women, and suicidal thoughts and wishes in 18% and 20% of women respectively. The main factors associated with depression and suicidal thinking in men were high local sex ratio, rural residence, low education and poor economic status. Very high local sex ratio was the strongest independent determinant of depression in men.
The researchers conclude that "proactive measures need to be taken to identify and treat vulnerable individuals."
Read more: Journal of Affective Disorders

Rice is worse for diabetes in Chinese than in Europeans

Glycaemic response to white rice is 60% higher in Chinese compared to Europeans
by Michael Woodhead
Researchers say Chinese people at high risk of diabetes should find alternatives to white rice, because glycaemic responses after eating rice are appreciably greater in Chinese compared with Europeans.
Writing in the journal Diabetic Medicine, they say diabetes rates are especially high in China, and risk of Type 2 diabetes increases with high intakes of white rice, a staple food of Chinese people.
In a study of  32 Chinese and 31 Europeans, the researchers tested blood sugar responses  following ingestion of glucose and jasmine, basmati, brown, Doongara and parboiled rice.
The glycaemic response was over 60% greater for the five rice varieties  and 39% greater for glucose amongst Chinese compared with Europeans. The glycaemic index (GI) was approximately 20% greater for rice varieties other than basmati rice.
"These findings have considerable potential clinical significance given the global epidemic of Type 2 diabetes and the especially high rates in Asian countries such as China where rice is a staple food, The researchers say.
"In view of the extent to which white rice contributes to the overall glycaemic load of the diet and the data which suggest a relationship between high
intakes of white rice and risk of Type 2 diabetes [5], it is conceivable that encouraging the use of rice with the lowest glycaemic index may reduce the risk of Type 2 diabetes.
"Alternatively, partial replacement of rice with culturally acceptable lower glycaemic index foods such as pulses might be a useful means of lowering postprandial glycaemia. The same dietary modifications may be appropriate in the nutritional management of people who have already developed diabetes."
Read more: Diabetic Medicine

Rural health insurance scheme favours the wealthy

Rural health insurance that covers outpatient treatment helps the poor
by Michael Woodhead

China's rural health insurance scheme often favours wealthier patients by covering inpatient but not outpatient services, a new report has concluded.
A review of almost 10,000 people covered by the New Rural Cooperative Medical Schemes (NRCMS)  found that health insurance was more likely to benefit the poor if  used to provide insurance that covers both outpatient and inpatient services rather than just inpatient services.
The analysis found that in areas where medical insurance cover was comprehensive and covered both outpatient and inpatient services rather than inpatient services only, there was significantly greater use of village-level and township-level outpatient services.
These services were used much more by poorer rural residents, whereas wealthier rural residents tended to use county-level inpatients services, the analysis found.
According to the researchers, poverty due to illness has become a substantial social problem in rural China since the collapse of the rural Cooperative Medical System in the early 1980s.
However, health insurance coverage for outpatient services at the village and township levels increased the access to outpatient services among people with lower incomes. In contrast, the increased use of the county-level outpatient services among the people with higher incomes suggests that the policy effect at the county-level was more "pro-rich" than pro-poor.
"Our findings suggest that health insurance that only covers inpatient services may result in reductions in outpatient utilisation, particularly at the village and township levels and among people with lower income," the report authors say.
"This result is consistent with concerns voiced by the WHO that people who are provided insurance only for inpatient service may delay critical outpatient and preventive services that can protect their longer-term health and reduce catastrophic illness. Chinese government at various levels are the major contributors to the New Rural Cooperative Medical Schemes premiums; these investments are more likely to benefit to the poor if they are used to provide insurance that covers both outpatient and inpatient services rather than just inpatient services," they conclude
Read more: PLOS One

Wednesday, 28 November 2012

Beijing hospitals drop 15% drug commission for patients

The 15% hospital mark-up on drugs encourages over-prescribing
 [translated] by Michael Woodhead
A pilot program in which hospitals no longer charge a 15% markup on all medicines is to be extended to more major hospitals in Beijing.
The scheme, which has been running at the Friendship Hospital and Chaoyang Hospital, is intended to de-link revenue from prescribing  and therefore remove the incentive for hospitals and doctors to over prescribe medications. The scheme will be extended from December to the Tongren, Jishuitan and Tiantan hospitals.
Yesterday, the Beijing Medical Reform Office held a press conference to announce that additional hospitals will cancel the 15% of medicines markup as well as an additional 42-100 yuan of medical service fees, including Medicare fixed reimbursement of 40 yuan.
A spokesman for the reform office says that  in addition to controlling medical behaviour the pilot will also remove barriers to care through registration
The director of the Medical Reform Office in Beijingr  Han Xiao-Fang said patients need not worry about having drugs cancelled after hospitals  implement the total payment system. If hospital costs overrun, doe of these will be borne by the government, but hospitals also need to take the initiative to lower costs.
"In the past, if patients spent more money, the hospital earned more money. After reform, hospitals can only earn service fees." Director Han said. In addition, lower medical supplies prices, will be another important way to reduce the burden on patients, he added.
Read more: China Medical Tribune

Hypertension risk for adults born during China's great famine

Adults born during the 1959-61 famine are likely to have growth retardation and hypertension
by Michael Woodhead
Babies born during the great Chinese famine of 1959-61 have a higher risk of hypertension and short stature in adulthood, research shows.
The 1959-1961 Chinese Great Famine  triggered by the Great Leap Forward appears to have had an adverse event especially  fetal development in the first trimester of pregnancy, according to researchers from the Department of Preventive Medicine, School of Public Health, Guangzhou Medical University.
They conducted a retrospective study of 12,065 adults aged between 46-53 who were born between 1957-1964 in  Guangdong province, China.
Their findings showed that the risk of hypertension was 1.4-fold higher in babies whose mothers were exposed to famine conditions during the first trimester of pregnancy, and 1.83-fold higher in babies experienced famine during infancy. People who experienced famine during infancy also had an increased risk of short stature, but not of obesity.
The researchers note that the 1959–1961 Chinese Great Famine, caused by a sharp drop in crop production and the “Great Leap Forward” policies, was the largest in human history, lasting approximately three years and resulting in about 30 million deaths and about the same number of lost or postponed births.
"Our study on the effects of early life exposure to the Chinese Great Famine strongly suggests a critical role for changes in exposure to famine during the fetal development period and from prenatal to postnatal life in developmental “programming” cardiovascular risk. Good infant nutrition appears to be beneficial whatever the fetus experienced in utero," the researchers conclude
Read more: PLOS One

Shanghai man in coma after taking adulterated health tonic

"Health tonic" contained sildenafil
A 73-year-old local man in Shanghai was revived from a coma after taking a "health tonic" found to contain the same active ingredient as Viagra, officials from the No. 411 Hospital of the People's Liberation Army said yesterday.
The patient, surnamed Zhang, said a saleswoman went to his neighborhood in Hongkou District a week ago to sell a medicine that she claimed were made from ginseng and Chinese caterpillar fungus, a TCM tonic said to help with immunity and cardiovascular health. He paid 350 yuan (US$55.56) for four packs and started to take the medicine.
He fainted suddenly at home on Monday and was rushed to the hospital, where doctors found that there was no ginseng or caterpillar fungus in the medicine but starch and sildenafil, the main ingredient in Viagra.
Doctor Bai Yingtang said the patient suffered a serious adverse reaction since he took drugs for heart disease regularly as well as the sildenafil, which affects blood pressure and the heart.
"If he had not received treatment in time, he could have died," Bai said. "The patient has been in stable condition after treatment."
Zhang's family found no producer's name or contact on the package and the number left by the saleswoman didn't work.
The Shanghai Food and Drug Administration "has been tightening its oversight, but residents, especially the elderly, must be careful about such claims and see a doctor for medicine, including traditional Chinese medicine, instead of purchasing health tonics randomly," said Du Bing, an official with the FDA.
Read more: Shanghai Daily

Chinese quack buster wins international prize

Fang Shimin has been awarded the Maddox prize for his work exposing scientific fraud and quackery in Chin
The Chinese science writer and sceptic Shi-min Fang is one of the two inaugural winners of the John Maddox Prize.
Sponsored by Nature and the Kohn Foundation, and stimulated and organised by the UK-based charity Sense About Science, the prize commemorates a former Editor of Nature, John Maddox. John was distinguished for his championing of robust science. The prize rewards individuals who have promoted sound science and evidence on a matter of public interest, with an emphasis on those who have faced difficulty or opposition in doing so.
China’s rush to modernise and the communist government’s celebration of science and technology have firmly embraced scientists and scientific achievements, sometimes uncritically. And into that permissive milieu has walked a plethora of opportunists ready to take advantage of the situation with padded CVs, fraudulent and plagiarized articles, bogus medicines and medical procedures carried out without clinical evidence.
In 2000, Shi-min Fang started to expose these escapades in his New Threads website. As an outsider, trained as a biochemist but turned science writer and commentator, he has done much of what the scientific community aims, but often fails, to do — root out the fakers.
For example, Fang called into question DNA supplements that were widely advertised as a means to rejuvenate the tired, the pregnant and the old. Eventually, the government issued warnings about the supplements. Fang seemed to especially relish smacking down powerful or popular scientists. He even challenged official support of traditional Chinese medicine. But his targets fought back, in one case with particular hostility. In the summer of 2010, thugs hired by a urologist attacked Fang with a hammer and, according to Fang, tried to kill him. Fang had previously challenged not only the efficacy of a surgical procedure developed by the urologist, but also his CV.
Fang imposes transparency on an opaque system. He has opened a forum for criticism and debate in a community that is otherwise devoid of it.
In an interview with New Scientist, Fang Shimin said he was "thrilled and honoured" by the award.
He said the reason science fraud was such a problem in China was "the result of interactions between totalitarianism, the lack of freedom of speech, press and academic research, extreme capitalism that tries to commercialise everything including science and education, traditional culture, the lack of scientific spirit, the culture of saving face and so on. It's also because there is not a credible official channel to report, investigate and punish academic misconduct. The cheaters don't have to worry they will someday be caught and punished."
Read more: Nature

Qinghai medical school under lockdown after protest

Tibetan medical students were unhappy about disparaging remarks
The Sorig Lobling medical school in Chabcha (Ch: Gonghe), eastern Tibet, continues to remain under military lockdown following yesterday’s mass student protests against the Chinese government. Also, three of its students, Wangchen Tsering of Ba County, Mama and an identified student, have been arrested.
IChinese armed forces continue to cordon off the school, keeping the students captive within the school premises. Parents and relatives, on the second consecutive day, have been barred from meeting the students.
Five students, who were severely injured in police beatings, are said to be in critical condition and have been shifted to a bigger hospital in Tsongon. Around 20 students are still admitted in hospitals in Chabcha. Chinese security personnel have not allowed them visits from their family members.
Yesterday, over a thousand students from the Sorig Lobling medical school carried out a massive protest, raising slogans for equality of nationalities, freedom of language, respect for truth, and re-establishment of governance.
In a short video clip that has reached exile, students can be seen running on the streets, raising slogans.
Chinese armed forces used violent force to break up the demonstration, injuring many young protesters in the process.
The protest occurred after local Chinese authorities distributed a ten-point political questionnaire to the students and gave “patriotic education” sessions that contained disparaging remarks against His Holiness the Dalai Lama.
Read more: click here

Female civil servants protest against gynaecological examinations

Students say employment-related gynaecological checks for female civil servants are intrusive and unnecessary
[translation] by Michael Woodhead
On November 26,  female students in the Wuhan (Hubei) Provincial Human Resources and Social Security Department mounted a 'flash' demonstration to protest against the current  mandatory female civil servant employment gynaecological medical checks.
According to protest organisers, the currently female civil servant recruitment examination, includes a gynecological examination, which they say is unnecessary and intrusive
"This  requires women not only to accept a vaginal speculum exam, but also answer questions such as the age of first menstruation cycle, amount of bleeding, the duration and so on.
  "We believe that the the entry examination program has nothing to do with the ability to perform in the civil service, and violates the privacy of citizens. We are therefore mounting a flash event to remind the relevant departments to get rid of the civil service gynecological entrance requirement," the organisers said.
  One student who participated in the "flash"said that according to the employment health check manual, the focus of the gynecological examination was to be for sexually transmitted diseases and malignancy, but normal work exposure does not cause the spread of STDs - and infections would not usually prevent a civil servant from properly fulfilling their duties. She also noted that STDs are best detected through blood tests not intimate examinations.
  Currently, Hubei Province, Human Resources and Social Security Department is yet to respond to the action of the students.
  A Zhongnan University Law School associate professor Lian Yungang said the imposition of  gynecological examinations for female civil servants' employment checks could be seen as employment discrimination, and contrary to Equal Opportunity provisions of China's labor laws and employment regulations.
  The requirements because they appear lack of purpose, are not "appropriate" and exceed the "principle of proportionality" beyond a reasonable range, he added.
Read more: China Medical Tribune

Children develop goitre as iodine supplementation goes too far

In some area, 8% of children have goitre from excessive iodine
by Michael Woodhead
In some parts of China almost one in ten children have goitre (enlarged thyroid glands) due to excess levels of iodine added to drinking water and salt, new research shows.
Iodine supplementation of salt was introduced in China in the 1990s to combat iodine deficiency which has been a long term problem i some areas.
However, the supplementation may have gone too far say researchers from Tongji University, Shanghai. They examined iodine levels in almost 1600 schoolchildren 8 to 10 y old from the 16 counties of China. They found that in each area, the median urinary iodine of schoolchildren was nearly or above 200 μg/L, which confirmed the effectiveness of the iodisation strategy.
However, in areas with an iodine content higher than 150 μg/L in the drinking water, schoolchildren had more than adequate or excessive iodine intake, which was associated with an 8% prevalence of goitre.
"Therefore, it is important to adjust the strategy of universal salt iodisation control in China," the researchers say.
Read more: Nutrition

News in brief ...

Cholera becoming resistant to antibiotics in China

Antibiotic resistance is observed with increasing frequency among epidemic Vibrio cholerae strains in China, researchers from Beijing have warned.
Since the 1990s strains of V. cholerae have shown a rapid increase in the prevalence of resistance to antibiotics such as  nalidixic acid, tetracycline and trimethoprim/sulfamethoxazole.
This study serves as a warning of the rapid dissemination of resistance in the past 20 years," say researchers from the State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing.
Read more: International Journal of Antimicrobial Agents.

China's medical demand for helium creates world shortage

A shortage of helium caused by increasing demand for MRI machines in China is beginning to affect other countries - and even Disneyland balloons.
Tokyo Disney Resort has suspended sales of Disney-character balloons, and at least one hospital in the country has suspended use of MRI because of a lack of helium .
In hospitals, liquid helium is used to cool electromagnets inside MRI machines
However gas wholesalers say helium stock have run out as demand for helium for hospital use has increased mainly in emerging countries such as China. This has resulted in an at least threefold increase in helium prices in the last decade, greatly increasing the cost of semiconductor production, which relies heavily on helium.
Furthermore, due to an accident at a helium production facility in the United States, the supply-demand balance has been very tight since July, according to an Iwatani division chief. The situation may not improve until next spring at the earliest, observers say.
Read more: Daily Yomiuri

Elderly Chinese suffer from untreated depression

Depression is a common condition among older patients attending primary care clinics in Beijing, and most people do not receive treatment, a study. has found.
 A study of 1275 adults aged over 60 years at a primary care clinic in urban China found that 11% had major depression, with depression more likely to occur in older people, females and those with a  lower educational level or living alone.
Less than 1% of these patients received treatments and yet more than 60% of patients with depression initially remained depressed throughout the 12-month follow-up period.
Read more: Journal of Affective Disorders.

Rural areas urgently need newborn hearing screening

Urgent measures should be taken by the Chinese government to promote newborn hearing screening in the rural areas, researchers say.
Newborn hearing screening has been successfully implemented in Chinese cities , but not in rural areas, according to the authors of a new report.
Researchers screened for hearing problems in 11,568 babies born in five rural areas of Hubei. Overall, about 92%  newborns had normal hearing but 8% had a high-risk of hearing loss. While 71% newborns passed the initial screening test, 58 infants were diagnosed as hearing loss, and the prevalence of congenital hearing loss among newborns in rural areas was 0.5% .
Read more: International Journal of Pediatric Otolaryngology

Spinal fractures increasingly common in elderly Chinese

There has been a five fold increase in spinal fractures among older people over the let decade, new findings from Sichuan show.
Doctors from the Department of Orthopedics, Xinqiao Hospital, The Third Military Medical University, Chongqing reviewed hospital records on all patients who was 60 years of age or older with spinal fracture at two university-affiliated hospitals between January 2001 and May 2011.  A total of 996 patients with spinal fractures were identified, of whom 35% were males. The annual incidence of spinal fractures among the elderly rose from 24 to 130 cases per 100,000 hospital admissions between 2001 and 2010.
The causes of spinal fractures include traumatic spinal fractures (72%), osteoporotic fracture with no specific cause (27%) and spinal fracture caused by tumour and tuberculosis (2%).
The lumbar region was the most common region of spinal fracture, followed by the thoracic and the cervical regions. Lumbar spinal fractures and thoracic spinal fractures were more commonly seen as a result of accidental falls from low heights and osteoporotic spinal fractures respectively. Spinal fractures usually occur outdoors causing by accidental falls from low heights, most frequently happen on the road.
Read more: Injury

Hospitals tricked into buying shoddy dentures

An unlicensed denture processing factory in Beijing has been ordered to suspend production for allegedly using recycled metal materials to make dentures.
The Beijing Jingjiayi Denture Processing Centre is also accused of using illegal cleansing cream to whiten the dentures to meet the requirement of hospitals and clinics.
The factory, in the city's Tongzhou District, has been ordered to suspend production after a local law enforcement team found it had no license following an undercover investigation by the newspaper.
The investigation found the factory melted recycled residue of metal materials to make dentures and used shoe polish and furniture cleansing products to whiten and brighten the dentures.
Since the purity of the metal was lower, the dentures would unavoidably have small holes on them. The poorly-made dentures were also likely to cause irritation in the mouth and other oral diseases if they were not disinfected under strict conditions, according to Shao Dongsheng, a former prosthodontist with Beijing Stomatological Hospital.
The unlicensed dentures and false teeth were sold to small- and medium-sized hospitals and dental clinics in Beijing at low prices.
Read more: Shanghai Daily

New 10-year medical training program will produce rural generalists

The new 10-year medical training will focus on producing 'generalists'
China has initiated a 10-year education program that aims at cultivating more high-calibre doctors and training more general medical practitioners to serve the countryside.
The program emphasizes improving medical students' capacity in clinical practices and will require them to go through training in medical ethics and a formal residency before they become doctors, according to a notice issued by the Ministry of Education on Monday.
A total of 125 Chinese universities have been designated as the first batch of higher-education institutions to lecture medical students under the scheme.
Unlike the United States, where medical graduates have to go through tough examinations and residency programs before they become doctors, the majority of Chinese medical students go straight to work after graduation.
Chinese medical graduates go through residency training as hospital employees. The quality of training is highly dependent on hospitals.
Under the 10-year program, medical students will have to go through two or three years' residency training before they become doctors or assistant to general medical practitioners in rural areas, according to the notice.
Read more: Shanghai Daily

Call for urgent action over soaring HIV rates in gay men in Beijing

One in twenty gay men in Beijing developed HIV during a year
 by Michael Woodhead

Urgent action is needed to tackle skyrocketing rates of HIV infection among gay men in Beijing, Chinese experts say.
Researchers from the Chaoyang Centre for Disease Control and Prevention, assessed the HIV and STD infection incidence among 797 men who have sex with men in Beijing who were initial HIV-negative in 2009.
After about one year, they found that 48 men (6%) had developed HIV infection, equivalent to a rate of  8 cases per 100 person years. For syphilis, 30 of 666 (4%) gay men developed infection, and for herpes 46 of 760 men developed HSV-2 infection during the follow up period.
The risk of HIV infection was highest in younger men (under 25), those who had more than one sexual partner and men with a lower educational level.
The researchers say theirs is the first large study to measure the incidence of HIV among gay men in Beijing and the results "indicate that the HIV incidence rate among MSM has increased dramatically."
They say Beijing has an "extremely high rate" of HIV infection compared with other cities in both China and around the world.
"Explanations for the exceptionally high and steady rise in HIV incidence among Beijing [gay men] are not entirely clear, but one possibility may be that Beijing's relatively vibrant [gay] culture facilitates greater disassortative sexual mixing between gay groups, which in turn can increase HIV background prevalence. The high HIV incidence rate and prevalence among MSM in Beijing indicate that the epidemic in this group is extremely serious and that effective intervention services are urgently needed," says Dr Li Dongliang and co-researchers
They add: "Given the synergistic relationship between STD and HIV infection, interventions for high-risk behaviours and treatment and management for STDs should be combined with HIV control and prevention initiatives among MSM in China. We believe data from this study will help guide future research towards innovative STD/HIV interventions for MSM in China, and mobilise government, public health and non-governmental communities to control the rapid transmission of HIV and STDs among Chinese MSM. Comprehensive actions are urgently needed and the time is now."
Read more: BMJ Open

Tuesday, 27 November 2012

China's medical schools produce 'underperforming' African graduates

Liberian medical council says poor selection of students to study in China may be to blame for underperforming graduates
Medical authorities in Liberia have called on the government to stop sending medical students to study in China because Chinese medical school graduates are substandard.
The Liberia Medical and Dental Council has called on the Ministry of Health and Social Welfare and the Ministry of Education to place a hold on awarding scholarship to medical students for study in China.
Speaking at a news conference held in Monrovia on November 26, the council through its Chairman, Professor Robert Kpoto, said medical practitioners graduating from Chinese medical schools are performing below expectation.
According to him, this could be that the selection process of these students for the scholarship program was not done properly.
"Medical practitioners graduating from Chinese medical schools are performing below expectation. They are even incomparable with doctors who are here. I mean, they are failure and something must be done about this," Professor Kpoto said.
"I want to think that something might have gone wrong in the selection and vetting processes of these students who have been given scholarship to study medicine in China," said Prof Kpoto. He recommended that the medical council be part of the entire selection and vetting processes so as to get the proper students for such scholarship.
Read more: AllAfrica