Thursday, 31 January 2013

Shanghai GPs have poor understanding of hypertension

Doctors' average score in a hypertension knowledge test was less than 50%
by Michael Woodhead
Doctors working in community care have a poor understanding of hypertension, a new survey shows, highlighting the need for continuing professional education for medical practitioners.
A survey carried out by Dr Qian Chen of the General Practice Department, Zhongshan Hospital, Fudan University, found that doctors had an inadequate understanding of the diagnosis, treatment, referral and community management of hypertension. The average score on a hypertension skills test was less than 50%, and knowledge varied with the age and training background of doctors, with some practitioners scoring as low as 10%.
The results came from a survey of 150 community-based medical practitioners in Shanghai, who were given questions based on China's evdience-based hypertension management guidelines.
Physician had a better understanding of hypertension if they were trained in a medical university anther than a professional school, and tif they were located in a training base rather than a community
healthcare center. Almost 90% of physicians reported being willing to attend training courses regularly and the preferred frequency was once every two to three months.
"Continuing education is urgently needed to ensure that physicians in general practice are
aware of and adhere to hypertension prevention and treatment strategies," they say.Increasing GPs’ awareness and understanding of hypertension prevention and treatment is necessary to reduce the prevalence of hypertension in China," they conclude.
Source: BMC Family Practice

Who will pay the medical bills for those with no children?

A recent road accident that left a childless Beijing couple seriously injured has renewed calls to establish a system that can provide financial and other help to couples who have lost their only child.
Liu Juan, 52, was taking an evening stroll with her husband Li Shuwen on Jan 24 when they were hit by a metal height-limit rod, which had been knocked over by a truck.
She remains in a coma in intensive care at You'anmen Hospital, with a brain injury, while her husband Li suffered four fractured ribs and a bruised lung.
Liu Fuli, Liu's brother, is the only relative who has visited the couple.
"The doctor told me she is still in critical condition and the best result for her may be that she remains in a vegetative state for the rest of her life," he said.
Liu says he is already feeling the pressure of having to cover the couple's medical expenses.
"The medical fees have reached 90,000 yuan ($14,500) and if my sister stays one more day in ICU, I will be given another bill for about 8,000 yuan," he said.
"Next week, I have to borrow money to keep them in the hospital," he said.
No official figures are available on how many parents in China have lost their only child, but experts suggest it could be as many as 2 million.
Others are now campaigning for the creation of a fund for childless parents who face huge medical and nursing expenses.
Du Peng, a director of the Gerontology Institute at Renmin University of China, said the government should speed up the creation of a support system for parents in similar situations.
A legal framework must be set up, for instance, to allow legal guardians to be chosen to protect the interests and rights of older people, who become too old or sick to take care of themselves, Du said.
The latest amendment of laws governing senior citizens' rights, which is expected to take effect in July, will provide the legal basis for the government to act, he added.
Source: China Daily

What the British NHS can learn from China

by Professor Mala Rao, Institute for Health and Human Development, University of East London.
China’s transformed economic and political status led to the UK closing its bilateral aid programme in 2011. Instead, the UK Department for International Development launched the UK-China Global Development Partnership Programme (GDPP) to foster collaboration in areas including the reduction of poverty and achievement of the millennium development goals globally. The programme will build on lessons from China’s unparalleled success in decreasing infant, child, and maternal mortality rates and from China’s recent reforms of its health sector. So the nature of “aid” from the UK to India and China is rapidly evolving into one of technical partnerships, with leaders in disciplines such as science and policy working together, and is intended to benefit the rest of the world as well as all three countries.
Despite the changing world order, compelling arguments exist for fostering these partnerships. Improving global health is vital to the UK’s domestic and international interests. The health of the UK population is closely tied to global health, which is determined by factors not confined to national boundaries, such as migration, trade, conflicts, and climate change. The case for the UK to improve national security by helping India and China strengthen their disease control systems, as well as those of other countries, is no more powerfully demonstrated than by the global spread of severe acute respiratory distress syndrome (SARS) in 2003, which originated in Hong Kong and Vietnam. Tackling large problems requires global cooperation, and the UK’s best chance of success is through partnership with the two most powerful emerging economies.
Trade is vital to the UK’s economy and is greatly influenced by global interdependence. China and India are home to 36% of the world’s population, and their economies continue to grow during the global downturn. China’s 12th five year plan has prioritised improvements in healthcare, social welfare, and education. In India too, an increase of public expenditure on health from 1.4% of gross domestic product currently to 2.5% is anticipated by 2017, giving an unprecedented opportunity to work towards universal access to quality healthcare.
Source: BMJ

Taiwanese hospitals and doctors welcome to set up in Fujian

Fujian province should encourage investors from Taiwan to set up wholly owned hospitals as part of an effort to promote cross-Straits cooperation in the health sector, according to a proposal.
In the proposal to the ongoing annual session of the Fujian legislature, the Fujian committee of the Taiwan Democratic Self-Government League, one of the eight non-Communist parties on the mainland, said the province should open wider in terms of cross-Straits medical cooperation.
According to the proposal, growing demand for high-end medical services shows the huge potential of the mainland's medical services market.
Taiwan investors are allowed to set up wholly owned hospitals in Shanghai as well as Fujian, Jiangsu, Guangdong and Hainan provinces.
But most Taiwan-funded medical establishments on the mainland are joint ventures. Issues such as investment in hospital's apparatus and management are likely to cause disputes between the mainland and Taiwan investors, the proposal said.
"In that case, the establishment of wholly owned hospitals can avoid the problem," said Luo Shaming, vice-chairman of the party's Fujian committee. Luo suggested Fujian's Xiamen city and the Pingtan experimental development zone should serve as the pioneer to host wholly Taiwan-invested hospitals.
Shanghai Landseed International Hospital, the only totally Taiwan-invested hospital on the mainland, opened for business in Shanghai on June 26.
According to the Ministry of Health, by the end of 2011, 22 Taiwan-funded hospitals, all joint ventures, had started operation on the mainland.
Fujian's first hospital created from joint mainland and Taiwan investments, Xiamen Chang Gung Hospital, was established in 2008.
Fujian Governor Su Shulin said recently that deepening cross-Straits ties, an effort including strengthening medical cooperation, will remain high on the government's agenda over the next five years.
Chen Qiuli, deputy director of Fujian's health department, pledged this month to offer Taiwan investors preferential policies on things such as land for construction, tax and insurance.
Chen also said the department will simplify procedures and policies on Taiwan doctors' applying for a practicing certificate.
Source: China Daily

Hepatitis E vaccine available in China

Hecolin, the world’s first hepatitis E vaccine, is now available in Xiamen, China, to protect against the liver-damaging virus that affects approximately 20 million people around the world.
Hecolin was developed by researchers from Xiamen Innovax Biotech Co., Ltd., and Xiamen University.
Gao Yongzhong, the general manager of Xiamen Innovax, said that Hecolin is available at Xiamen’s centers for disease control and prevention, community clinics, hospitals and other medical organizations for approximately $22.50, Xiamen Daily reports.
“I have participated in the whole research and development process of the vaccine,” Yongzhong said, according to Xiamen Daily. “The vaccine is just like our child, and we witnessed it grow up from the test tube to finally becoming a product for sale. We were so excited when the vaccine was finally launched.”
The vaccine was approved for production in December 2011 and went to market in China late last year after 14 years of research, clinical trials and development. Xiamen Innovax is now working with the Chinese government to offer the vaccine to high-risk members of the public. It is also working with international organizations to distribute the vaccine to countries in need.
On January 19, the Chinese Academy of Sciences and Chinese Academy of Engineering recognized the vaccine as one of the top 10 advancements in domestic technology and science for 2012.
Source: Xiamen Daily

Chinese Center for Disease Control and Prevention (CDC) works with US counterpart

by Dr Tom Frieden, CDC Director
 For more than 30 years, the US CDC has worked with China on public health issues that have benefited people of all nations.
Together our nations proved the benefits of folic acid which saved children around the world from birth defects. We are exploring novel approaches to HIV prevention, testing and treatment. We are researching risk factors for cardiovascular disease – one of the world’s leading causes of death. Along with other nations, China and the US are working together on influenza surveillance to better protect the world.
This week, I had an opportunity to discuss these achievements with my colleague Dr. WANG Yu, Director of the Chinese Center for Disease Control and Prevention (China CDC). The US CDC and China CDC Directors meet annually to decide our mutual priorities, explore ways to share what we’ve learned with other nations and expand upon our collaborative successes. This was the tenth anniversary of the US-China CDC Directors meeting which allowed for reflection on a few key 10-year benchmarks.
China has made great strides in public health over the past decade. In 2003, the world was in the grip of SARS which began in China and resulted in sweeping changes to global public health response. In 2013, China is actively strengthening its domestic public health detection and response system. Ten years ago, US CDC began to work in China on its growing HIV/AIDS pandemic. Now, Chinese HIV/AIDS clinics are testing innovative point-of-care technologies that will be distributed globally to use in other nations in their fight against AIDS. In 2001, US CDC’s Field Epidemiology Training Program began helping China CDC to build a force of disease detectives to identify and control domestic disease outbreaks.
Ten years later, China expanded its contribution to the global effort to eradicate polio by joining the Stop the Transmission of Polio (STOP) vaccination teams. Ten years ago, China had only eight sentinel hospitals conducting virologic influenza surveillance and a single national laboratory. Throughout the next decade, US CDC supported its partners in China CDC to improve the quantity and quality of its surveillance sites. In 2013, China’s influenza network spans 554 sentinel hospitals and 409 laboratories and is one of only five WHO Collaborating Centres for Influenza Reference and Research in the world.
US CDC congratulates China and its public health professionals for making a world of difference. Collaborating with China provides US CDC unprecedented opportunities to work with the largest population in the world on public health approaches that benefit the people of China, the US and the world.
Source: CDC Blog

Influenza severity gene more common in Han Chinese

Researchers have found that two out of three patients in China with a severe influenza infection have a genetic variant of the IFITIM3 gene, previously shown to affect the severity of influenza infection in patients in the UK. By contrast, only one in four people in China with mild influenza have this genetic variant.
This variant is more common in the Chinese population compared to Northern Europeans and is associated with the severity of influenza infection rather than susceptibility to the disease.
IFITM3 is an important protein that can efficiently restrict the entry of influenza and other human viruses such as coronavirus, Dengue virus and West Nile virus into human cells. A genetic variant of this gene, rs12252, reduces antiviral activity of IFTIM3 leading to a more severe infection.
"Professor Paul Kellam at the Sanger Institute in Cambridge and Professor Peter Openshaw at Imperial College London discovered this genetic variant was associated with severe influenza infection in Europeans, but this variant is extremely rare in Europeans," says Dr Tao Dong, Lead author from the MRC Human Immunology Unit, Oxford University. "We became interested in this because we noticed it is 100 times more common in China.
"It's vital that we continue to fund research that examines flu from the smallest details of our genetic code and in the populations around the world that continue to be vulnerable to infection."
The team examined samples from the 2009 H1N1influenza A pandemic in China. They found a strikingly large number of patients with severe influenza infections, had a CC genotype, or copies of the variant on both chromosomes. People with this CC genotype have a six fold greater risk of severe infection compared to people with other genotypes, or different genetic makeup.
The IFITM3 gene variant could have a strong effect on the distribution and control of influenza in China and in people of Chinese decent. This finding could help identify those at high risk of severe infection and help to prioritise those in highest need of treatment.
"Understanding why some people may be more severely affected by influenza than others is crucial in improving our ability to manage flu epidemics and potentially to prevent people dying from the virus," says Professor Paul Kellam, co-author from the Wellcome Trust Sanger Institute. "This research is important for the people who have this variant. Large scale testing of influenza patients for this variant, especially in Chinese hospitals, is now needed to determine the significance and utility of this variant for the prognosis, early intensification of treatments and prioritising of people for vaccinations."
Source: Sanger Institute

In China, celebrities think twice about selling snake oil

Song Dandan (宋丹丹) promoted OTC remedy linked to liver toxicity
A Chinese actress who endorsed a cold remedy for children, which according to rumors swirling around microblogs is "proven to be poisonous to children's livers," has received unexpected praise after stating that she will never again endorse any medicine products.
The claim, made by sitcom actress Song Dandan (宋丹丹) on Friday, has led to public debate over whether celebrities should be involved in promoting medicine, though the company has denied the medicine is harmful. Song made these statements after reading a popular microblog thread that stated that Youkadan, a cold remedy for children produced by the Renhe Group in Jiangxi Province, is dangerous to children's livers. The company has now changed the medicine's instructions to explicitly state it should not be used on children below one year old.
"I'm surprised to hear that Youkadan is harmful to children's health. My agent and I were extremely cautious when considering endorsing this medicine and we had heard that the manufacturer and medicine authorities had done comprehensive checks of the medicine," Song said on her microblog.
"If the claim on the Internet is true, I will sincerely apologize to customers through the media," she said, swearing that she will never again endorse any medicine products as she could not be sure of the products' true quality and nature.
The Renhe Group said on Saturday that they had changed Youkadan's medical instructions according to a State Food and Drug Administration's notice regarding drugs that contain adamantanamine hydrochloride.
Youkadan is not poisonous to children's livers, the Renhe Group claimed, adding that the administration decided to ban the use of the adamantanamine on children below one year old "due to a lack of evidence determining the effect and safety of the adamantanamine on the age group."
Though the Renhe Group's reputation has been cleared by the authorities, the episode nevertheless led to appeals that celebrities should refrain from endorsing food and medical products.
Song, who has played the role of a caring, responsible mother in sitcoms, also won the public's sympathy as she was one of the few celebrities that stood out and tried to shoulder her responsibility for endorsing a brand.
"I think Song's oath not to endorse medical products anymore is very responsible, because celebrities have a huge influence but don't have the means to check whether the products would be harmful to people," Hu Yuan, a pregnant woman in Beijing, said. "Celebrities should not abuse their influence to pursue personal wealth," she added.
"It's fine for celebrities to endorse any product they wish because it is not their job to determine a product's quality. But given the food safety issues and irregularities in China's medical and health care product markets, they should protect their reputation and not endorse products that look fishy," Shen Dong, a TV director in Beijing, told the Global Times.
On May 26, 2009, a legal interpretation was issued from the Supreme People's Court and Supreme People's Procuratorate, stipulating that any individuals that assist in the sale of fake drugs by advertising them will be treated as accomplices.
When dealing with drug advertisements, celebrities should not only check the medicine's drug approval number, but also consult professionals to check the credentials of the medicine and its producers' qualifications and quality, Zhang Yongjian, a food and drug expert with the Chinese Academy of Social Sciences, told the Global Times.
In April 2012, the Xiuzheng Pharmaceutical Group, a leading Chinese drug maker, was revealed to have been buying capsules containing toxic chemicals made by illegal drug makers. Though all the medicines involved had received approval from the authorities, the ten celebrities were still criticized for abusing their influence to endorse Xiuzheng's products.
Source: Global Times

Enterovirus vaccine safe and effective against hand foot and mouth disease, Chinese trial shows

A trial conducted in Jiangsu has provided major step forward in the development of  a vaccine against enterovirus 71 - a member of the Picornaviridae family of viruses associated serious and fatal outbreaks of hand, foot, and mouth disease across Asia.
Published in The Lancet,  the results of a phase 2 trial of an enterovirus vaccine in more than 1100 infants and children in Jiangsu found that the vaccine had good immunogenicity and a low incidence of adverse effects.
The inactivated EV71 vaccine developed by Beijing Vigoo Biological used the EV71 strain was given in two doses a month apart, injected intramuscularly into the deltoid region in children aged 12—36 months and into the anterolateral side of thigh in infants aged 6—11 months.
The trial compared four different doses of vaccine, and all procuced  good antibody responses, with the best seen with an adjuvant 320 U formulation.
Antibody titres had significantly declined by eight months, suggesting a need for a booster shot. Generally, the vaccine had a good safety profile in all participants. Most reactions were mild or moderate and severe adverse reactions were uncommon.
Researchers say an enterovirus  vaccine is a public health priority because mortality rates with enterovirus 71 are as high as 82—94% in severe cases and the incidence of hand, foot, and mouth disease seems to be increasing across the Asia region
As a result of our findings, the adjuvant 320 U formulation has been selected for larger multicentre, randomised, double-blind, placebo-controlled trial in about 10 000 participants aged six—35 months.
Source: Lancet

Wednesday, 30 January 2013

Payment reform fails to fill medical insurance abyss

by Tian Peng and Zuo Lin
After three years of expansion, China's medical insurance system now covers 95 percent of the population. However, as the world's largest medical insurance program, it has come under great pressure to make ends meet.
On the one hand, medical insurance funds nationwide are struggling to foot skyrocketing medical bills resulting from soaring medical costs and surging compensation standards. Meanwhile, the current medical insurance system, which already boasts universal coverage, leaves little room for expansion. Therefore, increasing funding size hinges on rises in urban employment, higher income levels, and larger government allocations.
Compared with their foreign counterparts, Chinese citizens spend a large percentage of their salaries paying for social security, namely endowment insurance, medical insurance, unemployment insurance, employment injury insurance, maternity insurance, and the housing provident fund. Given that social security contributions and taxes already take up over 25 percent of individuals' total wages, it would be difficult to raise the percentage any time soon.
Take Beijing for instance. The municipality's medical insurance fund experienced average annual growth rates of 20-30 percent between 2007 and 2011. In comparison, medical costs increased 50 percent in 2010 and 38 percent in 2011 and have been growing faster than average wages since 2008.
The public's demand for medical services is soaring while the medical insurance contribution-wage ratio is already high. The Center for Public Policy at the Institute of Economics under the Chinese Academy of Social Sciences (CASS) estimated that under the current system, most Chinese cities will see their medical insurance funds running out of capital before 2020, though they may vary in population size and age structure.
Given the circumstances, the top priority for policymakers is to ensure efficiency and fairness in the deployment of medical insurance funds.
Medical insurance funds worldwide generally pay hospitals in two ways: one is through a fee-for-service system under which hospitals are paid based on specific services they provide, the categories their services fall into, or the categories of illnesses they treat; the other is to pay hospitals fixed total amounts determined in advance (i.e. the "total prepayment" mechanism) or predetermine per capita amounts of payment and pay hospitals based on the number of patients they treat and predetermined price levels.
For a long time, hospitals in China have generally been paid based on specific services they provided. In other words, hospitals (doctors) that prescribed more medical examinations and drugs enjoy higher incomes. As medical insurance funds nationwide strive to keep down overall medical costs, the "total prepayment" mechanism is gradually gaining momentum.
The mechanism could effectively contain medical costs in the short term; however, on a closed medical service market where reform on the supply side lags behind and administrative forces play an increasingly larger role in allocating medical resources, payment reform alone could in effect "release demand while limiting supply," which in turn would make medical insurance funds unable to foot skyrocketing medical bills.
In the long run, opening up the medical service market should be the ultimate solution to adjust demand and supply and control medical insurance costs. An expert contends the first step of medical reform should be deregulating the medical service market, which is the simplest reform path with the least social impact.
Source: Caijing

Shanghai to set up 40 primary care training bases

By the end of the year, Shanghai will have at least 40 community training bases for general practitioners, a move by local government to promote the community-based medical service.
In 2010, Shanghai launched an innovative training program for medical students. Under the program, the first of its kind in the country, students who graduate from medical school after five years of study will have another three-year practical training period in clinical medicine at local hospitals.
During the three-year practice period, they should spend at least half a year at local community medical service centers to give them better knowledge about being a general practitioner, an official from Shanghai Municipal Health Bureau said.
Whether working as specialists at hospitals or GPs at community medical centers, these graduates should formally start their work only after they have passed all the evaluations during the three-year practice, the official said.
So far, the bureau has announced its first batch of 20 community medical service centers as training bases. The number will increase to between 40 and 45 by the end of the year, according to the bureau.
Source: China Daily

Tuesday, 29 January 2013

Iron and vitamin supplements not needed to improve pregnancy outcomes: Chinese study

Prenatal iron–folic acid and other micronutrient supplements provide no extra benefit to Chinese women in perinatal mortality or other infant outcomes beyond any benefit conferred by folic acid alone , a major study has shown.
In a randomized double-blind controlled trial, 18 775 nulliparous pregnant women with mild or no anemia were enrolled from five counties of northern China from May 2006 through April 2009. Women were randomly assigned to daily folic acid (400 μg) (control), folic acid–iron (30 mg), or folic acid, iron, and 13 additional vitamins and minerals provided before 20 weeks gestation to delivery.  Compared with daily prenatal folic acid, supplementation with iron–folic acid with or without other micronutrients did not affect the rate of perinatal mortality or other adverse maternal and infant outcomes except  for third-trimester maternal anemia.
Source: JAMA Internal Medicine.

'Retired' Hangzhou physicians are busier than ever in their eighties

Two retired doctors have become famous in Hangzhou's Cuiyuan Sanqu community.
Gynecologist Zhang Zhumei, 86, and pediatrician Rao Rujin, 86, have helped hundreds of people for free since retiring in 2006 from Hangzhou No. 2 People's Hospital. They were supposed to retire in the early 1990s, but later were rehired by the hospital due to their expertise.
The married couple jokes that they offer a one-stop package of services for pregnant women and those with young children.
During their career, both doctors earned strong reputations due to their excellent medical skills, and after they retired people asked for their contact information.
"A few sterile women found my apartment and I helped cure their infertility, so they gave my telephone number and address to more people. More people kept coming seeking help," Zhang says.
Nowadays, the majority of Zhang's patients are from suburban areas of Hangzhou such as Yuhang, Linping and Kangqiao although some have come from other cities after hearing about Zhang's expertise in helping women conceive.
Zhang says most patients coming to her have already had medical examinations in hospitals but still cannot conceive, thus they turn to her.
Zhang has helped numerous women conceive including one Hangzhou woman who saw doctors at several hospitals in the city.
Zhang checked her medical history and asked her symptoms. She then gave her a prescription. The doctor called her from time to time to track her condition and reminded her to take good care of her body. Six months later the woman became pregnant. The woman chose to give birth at Hangzhou No. 2 People's Hospital. In order to ensure the mother and child's safety, Zhang phoned her former colleagues to advise them on the patient's specific needs.
Eventually, the woman gave birth without any problems. When the infant was three months old, she took him to the couple's apartment, so Rao could do the check-up.
"The baby is really healthy," Rao says. "My wife helps women conceive and I help treat their babies, we provide a one-package service," Rao laughs.
Patients are required to book an appointment, but Rao and Zhang will also help when there is an emergency.
One day, a neighbor knocked loudly at their door around midnight. His child had a fever and was twitching. The father didn't know what else to do so he asked for Rao's help.
Rao took a look and prescribed some medicine. The child was fine within a few days.
Parents in the community often think of Rao when their child faces health problems.
Years ago, a girl in the community who was born premature was skinny and dying. Doctors in several hospitals were unable to save her. The parents brought her to Rao as a last resort.
Rao changed the toddler's medication and diet. She recovered and is now five years old.
Patients also admire Rao because of his ethics - he prescribes cheap and effective medicine whenever possible.
"Although our country's economy has improved, the living standards of most people are not very high," the pediatrician says. "Expensive medicine is a burden for common people. I have to help ease the pressure."
In their spare time, the doctors translate medical theses.
Thus far they have translated 700 theses from the American Journal of Obstetrics Gynecology, which was borrowed from the library. Zhang does the translation while Rao proofreads each thesis. They type all the translated theses into a computer and print them out.
Every once in a while, they give these translations to doctors at Hangzhou No. 2 People's Hospital.
"We should learn advanced medical skills from developed countries to help our medical science keep up with them," Zhang says.
Despite their age, they adhere to the concept of live and learn, and spend time keeping up on the latest developments in medicine.
Source: Shanghai Daily

A million Chinese babies a year born with congenital defects

As the Chinese Lunar New Year (February 10 this year) approaches, doctors and nurses in the Anhui Provincial Children's Hospital have one urgent wish: That the parents of an infant they just treated would come to the hospital to retrieve their daughter, nicknamed Yuanyuan—a name given to the baby by doctors.
When Yuanyuan was found abandoned at the hospital's entrance on December 15 last year, the then three-day-old was bundled in a quilt, with a note saying that she had been diagnosed with congenital esophageal atresia, a birth defect interrupting the passage between the esophagus and stomach.
Yuanyuan was weak, her lips blue from cold and oozing white foam, a nurse who was on duty told local Web portal
"If not operated upon in time, she would have died," said Liu Guanghui, Director of the Neonatology Department of the hospital, who said that food was entering her windpipe and mixing with inhaled air, causing vomiting, bloating and pneumonia.
Doctors operated on Yuanyuan to repair the defect. Jin Danqun, a doctor in the hospital's Intensive Care Unit, said that the girl had recovered completely, and grew from 2.7 kg to 3.5 kg during her month in the hospital.
"Now that Yuanyuan has been cured, we wish her parents will take her home. Do not leave such a young child parentless," Jin said.
Growing defects
Each year, about 900,000 babies with congenital defects are born in China, accounting for 5.6 percent of all newborns, according to a report on the prevention and treatment of birth defects released by the Ministry of Health in September 2012.
Some of the most common birth defects in China in the past decade are congenital heart diseases, extra or webbed digits, cleft lip or palate, neural tube defects, hydrocephalus (water on the brain), club foot and microtia, according to the report.
Like Yuanyuan, many babies with birth defects, especially those born to poor families, are abandoned by their biological parents.
The report shows that perinatal period birth defect incidence in the country has been on the rise. The overall incidence rose from 107.79 per 10,000 live births in 2000 to 153.23 per 10,000 live births in 2011.
But the trend differs for specific types of defect, the report says. The incidence of some pernicious birth defects sensitive to intervention measures has gradually declined. For instance, the incidence of neural tube defects dropped from 27.4 per 10,000 live births in 1987, the most prevalent defect that year, to 4.5 per 10,000 live births in 2011, the eighth most prevalent. During the 2000-11 period, the incidence of neural tube defects went down by 62.4 percent in China's urban areas and 72.8 percent in rural areas.
In the same period, the incidence of congenital heart diseases increased sharply partly due to progress in diagnosis, the report says. In 2011, the incidence of congenital heart diseases was 3.56 times that of 2000.
The report also reveals that as infant mortality caused by infectious diseases has dropped, birth defects have risen to be the second largest cause of infant mortality in China, attributing to 19.1 percent of infant deaths.
There are a wide variety of congenital defects and they can be caused by different factors. "So far, at least 8,000-10,000 types of birth defects have been identified in China, 25 percent of which are inherited, 10 percent are caused by environmental factors and the causes of 65 percent remain unknown," Zheng Xiaoying, Director of Peking University's Institute of Population Research said.
Source: China Youth Daily.

'Leprosy Island' legacy in Guangdong

by Yang Wanli
About 26 kilometers away from the shore of Taishan city in South China’s Guangdong province lies a small island called Daqin. It is neither a summer resort for residents in nearby metroplices of Hong Kong and Macao, nor a haven of peace and happiness for local fisherman.
The island was once home to people referred to then as mafeng lao, a scornful name given to people suffering from leprosy.
Co-funded by US missonaries and Chinese officals, Daqin was the biggest among Guangdong’s more than 100 colonies to separate leprosy patients from healthy residents. Nearly 2,000 paitents were isolated on the island since its establishement in 1924, leaving 44 residents with an average age of 75 in January 2011. Some were blind and bedridden; others lost fingers, toes or entire limbs to the disease.
Wu Yunqi lived on the island for nearly 60 years. Infected with leprosy at 13, he was diagnosed about 18 years later and sent to Daqin without seeing his family members ever again.
There is no tap water, no electricity, no TV set and sometimes nothing more than salted vegetables to eat in typhoon season. People living on Daqin were connected with the rest of the world by a small wooden boat, which came once or twice a week. Life on Daqin Island was counted day-by-day.
For the past half century, 90-year-old Wu has prayed everyday to gain spiritual support as he copes with the disease that left his a lower leg with many horrible scars. He said there is a greater hope in his heart that becomes stronger as ages: to see his children again.
In 2011, the last 44 patients on Daqin Island were transferred to Si’an Island next to downtown Dongguan, a city famous for its foundary business for overseas enterprises. The move was part of a government project to improve the living conditions of people suffering from the disease. Si’an Island is a mere five-minute trip to shore, versus a trip that took one hour from Daqin Island.
A physician in Si’an said many lepers’ family members and their relatives refused to visit the island due to the historial discrimination towards lepers. Even today, the prejudice still exists. In those areas that the disease had broken out in early decades, people are unwilling to marry their child to someone with a family history of leprosy.
At least half of the staff working at a leprosy hospital in Si’an married one of their colleagues, the physician said. Some doctors and nurses refused to be in photos or named in the report to avoid any possible negative influence to their family members.
Wu believes that moving closer to the shore improved his chances of seeing his family again. However, the chances are still strong that he will finish his life a lonely man.
In late 2012, Wu’s story became popular in local media, and people eventually found his son, 63, and daughter, 61. But sadly, they refused to visit the island and see him. The only image Wu has of his children is a photo of them with his mother that his son sent to the island in the 1970s.
Source: China Daily

China's most needy missed out on medical insurance

When Liao Dan, a 41-year-old Beijing resident, appeared in the Dongcheng District People's Court on July 11, 2012, facing charges of defrauding Beijing Hospital of medical fees, sympathy was so overwhelming that some netizens called for his acquittal.
Liao had forged an official stamp to evade medical fees for his wife, Du Jinling, who suffered from acute kidney disease. The couple, married 15 years with a 12-year-old son, earned little more than the government living allowance of 1,700 yuan ($270) per month. Laid off during a spate of state-owned bankruptcies a decade earlier, the meager and unstable income Liao earned as a manual laborer was nowhere near enough to cover the costs of Du's biweekly dialysis treatments, nearly 5,000 yuan ($794) per month.
Since Du is from Yixian County, Hebei Province, and does not have a stable job in Beijing, she would have had to return to her hometown to receive treatment eligible for medical insurance reimbursements. Liao doubted his wife could stand frequent travel between Yixian and Beijing. Sobbing several times during court, Liao testified, "I could not find any other way and just wanted to keep her alive."
According to Liao's lawyer, money donated by the owner of a software company in southern Guangdong Province to cover the medical expenses owed was among the reasons the court showed lenience in sentencing Liao on December 7, 2012. Instead of sentencing him to up to a decade in jail, as proposed by prosecutors, the court fined Liao 3,000 yuan ($476) and gave him three years in jail with four years' reprieve for defrauding the hospital of 172,000 yuan ($27,300) from September 2007 to November 2011.
Netizens donated over 500,000 yuan ($79,400) to pay for Du's future treatment.
Although China's basic medical insurance program had covered more than 95 percent of its population by the end of 2011, Liao's case once again sheds light on the urgency for the country to institute a universal social safety net to protect the most vulnerable and disadvantaged groups.
Sun Shuhan, a professor at the Beijing-based Renmin University of China, said people like Du, who are married to Beijingers and work and live in Beijing, should be able to have their medical bills refunded locally rather than be forced to return to their hometowns for treatment.
However, Lu Xuejing, a professor at Capital University of Economics and Business who studies social security policies, stands in opposition. She said that if government-sponsored medical insurance is available to all immigrants living in Beijing, it would place an enormous burden on medical facilities in the capital, where the most advanced medical resources in the country are located. "The local budget will not stand the pressure either," she said.
China's medical insurance system is segmented as each province has its own medical insurance fund, which only pays for the expenses of its registered residents.
Gu Xin, a professor at the School of Government of Peking University, said that in the long run, difficulties faced by families like Liao's could only be solved if medical insurance accounts were better consolidated fro smooth transfer between localities around the country.
Gu said that he had designed a universal health insurance system, where each citizen pays an annual premium of 200 yuan ($32) him or herself and receives 500 yuan ($79) in subsidy from a state-financed national health fund. The 700-yuan ($111) annual premium is calculated based on China's current medical consumption level. Under Gu's proposal, premiums for low-income earners would be entirely paid for by the government.
Source: Beijing Review

Influenza difficult to control in China

by Shan Juan and Peng Yining.
Clearly understanding the symptoms of influenza is vital to combating the disease, experts say.
In 1998, Beijing's funeral services were strained by a higher-than-average number of flu-related deaths, said He Xiong, deputy director of the Beijing Center for Disease Control and Prevention.
"I got a call from the Beijing civil affairs department asking why there had been more deaths than usual. I told them that it was because of a higher incidence of flu," recalled He.
However, despite greater awareness over recent years, "many people are still unable to distinguish flu from a common cold and therefore greatly underestimate the hazard it poses", he warned.
So far this winter, eight flu-related deaths have been reported in China, seven of them in Beijing, according to the Ministry of Health.
On Dec 27, a 22-year-old migrant worker, infected with the H1N1 strain, died, becoming the first flu-related fatality in Beijing of the winter.
According to the Beijing CDC, on Dec 25 the woman had a severe cough but by the next day had developed a high fever.
Because she had difficulty breathing, the patient was sent to the Beijing Chaoyang Hospital on Dec 27, but she later died as a result of acute respiratory failure.
According to reports, the patient was anemic and in poor health when she became infected. The same was true of a second victim of H1N1, a 65-year-old woman in the terminal stages of bone marrow cancer, who died on Jan 4. Neither of them had received a flu vaccination.
The number of cases of flu and related fatalities in Northern China is expected to rise before winter ends, according to Shu Yuelong, director of the National Influenza Center, under the Chinese Center for Disease Control and Prevention.
Cold, dry winters often see a rise in the incidence of flu, according to He Xiong. That rise is exacerbated by the fact that people tend to spend more time indoors, further increasing interpersonal contact, particularly in public places, and allowing more opportunities for the virus to spread, he added.
"Spring Festival, which sees a huge number of people take to the roads for family reunions, also increases the risk," he warned.
From a socioeconomic point of view, the illness "likes the rich but is isolated from the poor", he said, pointing out that the spread tends to be wider in places where economic activity and interpersonal contacts abound. "It's complex and has both natural and social determinants."
Shu was of the same opinion, but ruled out the possibility of a flu pandemic this year because there have been no mutations to the known viruses. The H3N2 and H1N1 strains have predominated this season, with H1N1 being more prevalent in Beijing, he said.
"So far, flu activity is within the normal range compared with previous years and people are familiar with the dominant viral strains," he said, adding that surveillance is ongoing.
Read the full article: China Daily

Saturday, 26 January 2013

Parents angry as children used in secret trial of vaccine for hand foot and mouth disease

Angry parents have accused a township health service center in Taixing, Jiangsu Province, of using their children as guinea pigs after it was found to have injected more than 100 of them with vaccines still under clinical trial.
Both the health center in Fenjie Town and the Taixing City Disease Control Center admitted that the vaccine was not yet on the market but insisted that the trial had been approved by parents, the Modern Express reported yesterday.
However, parents said they had no idea it was a trial when their children took part in January last year.
Li Wei said the center had asked him to bring his two-year-old daughter to have a free hand-foot-and-mouth disease vaccine a year ago. He understood that 200 children would be taking part in the inoculation program.
"I felt confused as I was told my daughter needed to have blood tests regularly after the inoculation," Li said.
Li told the newspaper that his daughter had tested positive in two blood tests, but the newspaper did not specify what the tests were for.
He told reporters he searched online and found that the vaccine had not been approved for use but was still under clinical trial.
Another parent, Fang Yun, told the newspaper that her daughter had contracted hand-foot-and-mouth disease two months ago and said a worker at the center had told her secretly that the vaccine had some problems.
"No one ever told me it was a trial," Fang said.
An official surnamed Gu at the center told the newspaper the program was nationwide and the center was just one of many places where it was carried out. The trial was conducted with the approval of parents, Gu added.
Yao Genhong, an official with the disease control center, said parents had all signed on agreements for the project, but he failed to provide any documentation when asked.

Health official suspended in nepotism probe

Qu Songzhi of the Chengdu health department
A senior health official and wife of the dismissed deputy Party secretary of southwestern Sichuan Province has been removed from her position at the Chengdu branch of the Red Cross Society of China.
An unnamed official with Chengdu Red Cross said Qu Songzhi had not been at work since her husband Li Chuncheng was put under investigation.
Li was removed from his positions for suspected "serious discipline violations" only one month after he was also elected a non-voting member of the Chinese Communist Party's central committee during the 18th Party National Congress last November. Li is currently under investigation by the Party's discipline department.
Chengdu government officials said Qu was a hospital worker before her husband was appointed Chengdu City Party chief in 2003. She quickly gained several promotions afterwards to become a section chief in the city health bureau.
She became Party secretary of Chengdu Red Cross in 2009.
On, Shen Yong, who claimed he was a police officer, published six posts about Li, calling him "Li Chaicheng," meaning destroyer of cities.
In his online posts, Shen claimed that Li had "bought" his posts, and to recoup his outlay, had created a department and promoted his wife.
Li is said to be the most senior official to be investigated for corruption since Xi Jinping became the Party's leader.
Xi has launched a campaign against corruption also targeting the petty bureaucracy and infractions of low-ranking officials who are the bane of many people's everyday lives.

Thursday, 24 January 2013

Dear Readers: an Apology

You may have noticed that posting at China Medical News has been a bit light of late. If you subscribe to the daily newsletter I regret that this has also missed a few issues. Unfortunately, CMN is a non-paying 'hobby'  of mine and I have to pay the rent. I have been working long hours on the day job and there just aren't enough hours in the day for me to also write for CMN. It's a shame as there are some great stories out there in Chinese medicine that I know about but haven't been able to cover.
So if you're a publishing tycoon or private equity whizz and want to invest in an amazing publishing opportunity in the world's most exciting and fastest growing healthcare market  (and pay me a living wage) - please let me know and we can resume normal transmission ASAP.


Michael Woodhead

China to train 60,000 GP teachers

The Chinese government will train 60,000 general practitioner (GP) teachers by 2015, according to a circular published by the Ministry of Health on Wednesday.
A GP is a medical practitioner who treats acute and chronic illnesses and provides preventive care and health education for all ages and all sexes.
Jointly issued by the Ministry of Health, the Ministry of Education, the Ministry of Finance and the State Administration of Traditional Chinese Medicine, the circular says candidates for GP training will be classified into three categories: core GP teachers, clinical GP teachers and grassroots GP teachers.
According to the circular, training will last no less than two months and focus on clinical GP teachers and grassroots GP teachers, with the goal of training 6,000 core GP teachers.
The circular stipulates that clinical GP teachers should have a bachelor's degree or above and be qualified as an attending doctor or above. Grassroots GP teachers are expected to have finished junior college and be experienced in clinical practice and public health service.
The Ministry of Health will set up a database of core GP teachers, while provinces nationwide will establish their own databases of GP teachers, the circular said.
Source: EastDay

Children of rural migrants get NGO health checks in Beijing

by Simone Cote
A number of private organizations such as NGOs and individuals are helping migrant workers' children to get medical check ups.
As more and more migrant workers are flocking to big Chinese cities like Beijing to find work, they often bring their children with them hoping to provide them with a better life.
Simone Cote has more:
Recently a group of 46 migrant school children between the ages of 8 and 10 years old all had the opportunity to have their first ever annual health check ups at the Global Care Hospital in Beijing
Founded in 2009 by Helen Boyle, the Migrant Children's Foundation also known as MCF is a non profit organization that works with migrant communities in Beijing, China.
Helen says that for almost every child that has received a health care check up, it is their first time to visit the doctor.
"They don't have a check up at all in fact a lot of them if they have health issues, the parents they can't afford to actually, to actually seek treatment. So this is something for them for the parents to be sure that the child is ok, but also you know like what I said if there is an issue, they actually can tackle it from you know an early phase."
For most of the children, they say when they are sick they still have to attend school because their parents have to go to work.
The Director of the Health Management Centre for the Global Care Hospital, Wei Changhong says that while generally most of the migrant children are healthy, there are some common problems she has seen in the recent health check ups for the children:
"According to my experience, one common problem is about nutrition. The other is about development, such as whether their bones are healthy enough and whether they are tall enough. We use instruments, such as the weighing-machine to do a comprehensive assessment for children, and then we can see their health conditions".
And while there are still many more migrant children on the list to receive health care check ups in the coming year, Helen says that the MCF in collaboration with the support of the Australian Chamber of Commerce and the Global Care Hospital hundreds of more children will receive free health care check ups in the coming year.
Source: CRI

China's RMB14 billion insulin market monopolised by three western pharma companies

Demand within the Chinese insulin market has grown at a fast pace in the past decade. Over the next five years, both production and demand will continue to grow.
China is the country with the largest number of diabetics. In 2011, the market scale of diabetes medicine in China approximated RMB13.8 billion, of which, insulin medicines comprising recombinant human insulin and insulin analog accounted for 52.8%.
Insulin is a peptide hormone, produced by beta cells of the pancreas, and is central to regulating carbohydrate and fat metabolism in the body.
Insulin causes cells in the liver, skeletal muscles, and fat tissue to take up glucose from the blood. In the liver and skeletal muscles, glucose is stored as glycogen, and in adipocytes it is stored as triglycerides.
Due to high technological content and entry barriers, Chinese insulin market is monopolized by foreign corporations. In 2011, the combined market share of the three world-renowned pharmaceutical tycoons including Novo Nordisk, Eli Lilly and Company, and Sanofi Group hit 90% in the Chinese market.
By contrast, the largest domestic counterpart- Tonghua Dongbao Pharmaceutical -occupied merely 3.4% or so.
Denmark-based Novo Nordisk is not only the leader in global insulin industry, but also a major supplier in China's insulin market with the recombinant human insulin market share of 76% and the insulin analog market share of 53% in 2011.
America-based Eli Lilly and Company is the second embarking on Chinese insulin market, with the recombinant human insulin market share of 17% and the insulin analog market share of 8% in 2011.
Source: Companies and Markets

Wednesday, 23 January 2013

Ministry of Health revises list of occupational diseases

The Ministry of Health (MOH) on Tuesday began soliciting public opinions on its revised list of ailments considered occupational diseases.
The catalogue of diseases occurring as a result of work and which may therefore be given special consideration under insurance has been newly amended to include AIDS contracted by medical staff through exposure at work.
The revised regulation includes 130 kinds of occupational diseases and adds 17 work-related illnesses to the list. However, chlordimeform toxicosis has been removed from the list as manufacture and use of the chemical that causes it has been prohibited, according to the MOH.
The amendment also classifies occupational diseases into 10 categories, which specifies work-related lung diseases and other respiratory illnesses as one major category.
Of the newly added ailments, five are related to lung diseases caused by metal powder, erionite, double chlorine methyl ether and other materials.
For lack of necessary protection, pneumoconiosis is a major occupational disease in China, especially among miners.
Statistics from (eliminating pneumoconiosis with love), a charitable foundation established to help treat migrant workers who have developed the disease, show that about 6 million rural Chinese are affected by the disease.
Source: CRI

Hospitals refuse amyotrophic lateral sclerosis baby

A woman with Lou Gehrig's disease is due to give birth soon, but she is still not sure whether any hospital in Beijing will take the risk of performing a Cesarean section on her.
As a teenager, Lyu Yuanfang, 31, was diagnosed with Lou Gehrig's disease, also known as amyotrophic lateral sclerosis, or ALS, a fatal, incurable neuromuscular disease that progresses rapidly.
A native of northwest China's Gansu Province, she arrived in Beijing with her husband Luo Zhongmu last month and rented a home in the city's northeast Chaoyang District. Since then, she has been searching for medical facilities willing to assist her delivery.
"We don't know anyone here in Beijing, and all the hospitals we visited said they were unable to operate on an ALS patient," Luo told Xinhua in an interview on Monday.
Lyu is now 34 weeks pregnant and test results show that the fetus is healthy. Doctors have urged her to have a C-section before the fetus reaches 36 weeks, in case her own health deteriorates and threatens both herself and the baby.
Before they arrived in Beijing, a Sino-Canadian joint-venture hospital for women and infants offered Lyu free prenatal tests and delivery services.
But after a series of tests, the hospital's management decided Lyu's case was too risky, as the hospital has neither the proper equipment nor respiratory and neurological disease specialists.
"We readily agreed to help and exempt her from all medical charges, because we did not know her case was so serious," a senior manager of the hospital said on condition of anonymity. "We are apparently not qualified to perform China's first Cesarean section on an ALS patient."
Wu Shiwen, a neurologist with the General Hospital of Armed Police Forces, said Lyu's disease may cause respiratory system failures during delivery.
"The risk is high -- actually it's too risky for an ALS patient to be pregnant at all," said Wu.
Source: People's Daily

Tuesday, 22 January 2013

Another doctor murdered: female neurologist killed making house call in Baotou

The killing of an emergency doctor during a house call in Inner Mongolia on Saturday has again raised concerns about medics' safety.
Baogang Hospital in Baotou, the Inner Mongolia autonomous region, said on its official website that Zhu Yufei, 34, a woman doctor in its neurology department, was killed while on a home visit on Saturday.
According to the hospital, at 1:42 am it received a call from the city's emergency medical center reporting that a woman was experiencing convulsions and needed immediate help. When Zhu, the doctor in charge, and three medics arrived at the scene, a man, suspected to be Li Xinglong, attacked them with a cooking knife, locked the three medics outside, and allegedly killed Zhu in the house.
Huang Qiang, head of the police station in Kunlun district, Baotou, where the killing took place, told Xinhua News Agency that Li's 17-year-old son called emergency services that day, after witnessing his father beat his mother with a rolling pin, breaking her arm.
According to Huang, the son left with his mother before the medics arrived, fearing Li may beat her again.
When the medics arrived, Li let them in, telling them his wife was on the balcony before attacking them. The three medics escaped, but Li grabbed Zhu, locked the door and allegedly killed her. Zhu was dead when the police entered the house.
Baotou police confirmed on their micro blog account on Saturday, that they received a report a homicide had occurred at 1:58 am, and captured the suspect at the scene.
It's not known if Li's son also called police or if the medics knew that Li had earlier hurt his wife. A staff worker at the hospital said when the initial call came in nobody was expecting danger.
The motive for the killing is unknown.
Zhang Lei, an emergency medical worker since 1992, said the case is "extremely rare".
"When receiving a call, we ask the caller the cause of the patient's condition," said Zhang, who works in the Beijing Emergency Medical Center. "Sometimes we also call the police to go to the scene with us."
"We would suggest the police come along if the situation involved violence, such as when a beating occurs. However, sometimes it's hard to decide if we should ask police to cooperate because some callers tend to exaggerate the situation and waste police resources," said Zhang.
Zhang said he worked with the police when a mentally ill patient became violent, or when the medics needed police to rescue a patient locked inside the room.
Zhang said the incident could not have been anticipated.
"I have received training on how to protect myself from patients who are not conscious of their behavior, such as drunk people or people with mental illnesses, but not this," he said.
The Chinese Medical Doctor Association said in a statement on Sunday that it strongly condemns the killing, and it is paying close attention to the case.

Nanjing man with kidney failure survives for 13 years with home-made dialysis machine

Hu Songwen: "The principles of hemodialysis aren't complicated."
by Cang Wei and Song Wenwei 
An impoverished uremia patient has moved the public by constructing his own hemodialysis machine to stay alive.
Doctors agree it's a miracle that Hu Songwen has survived for 13 years because of his homemade hemodialysis machine.
The man recalls his life fell apart when he was diagnosed with uremia in 1993. He was a 21-year-old Nanjing Institute of Meteorology senior.
That morning, his face swelled. He had difficulty urinating. And he couldn't even stand on his own.
A medical examination showed both of his kidneys had failed.
The institute paid Hu's expensive medical bills for a year. It then sent him home to Qutang township in Jiangsu province's Hai'an county.
Hu's parents were factory workers, but each hemodialysis session cost 400 yuan ($64). At that time, his parents earned less than 1,500 yuan a month, but Hu needed more than 4,000 yuan every month to live.
The parents had done everything possible to save their son. In less than a year, they sold all their valuables and borrowed money from all of their relatives. After the money from the government and Hu's friends were spent, they couldn't afford food or housing.
"Do nothing but wait for death?" Hu says.
"I couldn't."
After reading books about the principles of hemodialysis, Hu - who excelled at chemistry and physics in high school - bought a cheap secondhand blood pump online and asked an acquaintance to purchase hemodialysis tubes.
"The principles of hemodialysis aren't complicated," Hu says.
"I had confidence I could overcome the difficulties I'd face."
On March 31, 1999 - a day he says he'll never forget - his homemade hemodialysis machine, filled with purified water and drugs, started to operate in his home's bathroom, which is smaller than 5 square meters.
Every tube used for hemodialysis costs about 100 yuan. To save money, Hu uses each more than 10 times, while they're only used once in hospitals.
He doesn't share the fears of many people around about bacterial infections and pollution.
"I just need to master the drug dosages and make sure to avoid getting any air in my veins," he says.
He used ceramic bowls to pour purified water into a steel pot, and heats the medicine in the microwave.
His 81-year-old mother, Huang Zhongfang, is his only hemodialysis assistant. She uses an old wooden scale to measure the fluid with her trembling hand and then feeds it into the machine.
Read more: China Daily

Monday, 21 January 2013

In China, depression goes untreated due to stigma and lack of psychiatrists

China has only 15 psychiatrists per million people
In China, long-standing social stigma around depression is a major obstacle. 
In rural areas in particular, people lack awareness and those with depression are often written off as being simply too lazy to do anything. Other times, people with mood disorders are considered insane and patients and their families are usually embarrassed or ashamed to do anything about it.
A lack of understanding is another factor. People mistakenly believe that they can simply get better through sheer willpower. An online survey by the World Psychiatry Association and in July 2012 showed that about 45 percent of respondents said they wouldn't go to a hospital if they had depression. Over 75 percent of them believed that they would not need to see a doctor or be medicated.
Among those who do choose to seek help, most visit general hospitals, which highlights the importance for doctors in community hospitals to receive psychiatric training and learn how to recognize and diagnose depression.
The survey showed that of the patients who went to treat cardiovascular, gastrointestinal or other diseases in general hospitals, over 20 percent also had clinical depression or anxiety disorder, said He Yanling, director of clinical epidemiology at Shanghai Institute of Mental Health, the Xinhua News Agency reported in July last year. But the diagnostic rate in general hospitals remains abysmal.
There are about 20,000 registered psychiatrists in China, which translates to about 15 psychiatrists per million people, according to Xinhua. There are also around 40,000 certified counseling psychologists in the country, but they do not have the legal right to prescribe medication for depression but only offer counseling as a complement to treatment.
Not only is professional help limited by these numbers but the abilities of these professionals vary greatly. Many people who suffer from depression have been bounced around between several different doctors who all fail to give them the help they need.
Read the full article: Global Times

Friday, 18 January 2013

Schistosomiasis a huge and overlooked problem in 'non endemic' areas of China

Migrants are spreading schistosomiasis to non-endemic areas
by Michael Woodhead
Urgent action is needed to improve control of schistosomiasis which is out of control in areas of China that are supposed to have no endemic disease, experts in parasitology have said.
China has an effective system of screening and treatment that has been set up in endemic areas  for schistosomiasis, which is caused by trematode blood flukes of the genus Schistosoma, says Dr Zhou Xiao-Nong of the National Institute of Parasitic Diseases at the China Centres for Disease Control.
However, a recent case in a non-endemic area showed that even patients with advanced disease are unable to get adequate and timely diagnosis  and treatment in many parts of China, he says. This especially applies to migrant farmers workers who may travel from endemic to non-endemic areas, says Dr Zhou.
He cites the example of a woman from a nonendemic area within the Anhui Province of China who had advanced schistosomiasis. During a period of one and a half months, the patient went through two hospitals, one preventive institute, and two regional schistosomiasis control stations, three of which she had been admitted into for medical treatments. Although the patient was not misdiagnosed from the beginning, she did go through five medical or health service facilities in pursuing medical treatment, covering a distance of nearly 1,000 km. Dr Zhou says diagnosis and treatment of schistosomiasis with praziquantel should be relative straightforward if a system is in place.
"Due to an unprecedented migration rate of populations in China as well as in other developing countries the number of such missed or ignored advanced cases could be huge.  Therefore, an improvement in the current monitoring system and aid-project management (i.e., enrolling vulnerable populations who have migrated from an endemic to nonendemic areas)  is clearly and urgently needed. This seems of great importance when the control and elimination of schistosomiasis has been put on the agenda," he concludes.
Source: PLOS Medicine

SARS was a watershed for China public health domestically but not globally

by Chan Lai-Ha
In 2002, SARS not only exposed a fundamental shortcoming of China's public health surveillance system as well as its single-minded pursuit of economic growth since the late 1970s, but also forced China to realise that, in the era of globalisation, public health is no longer a domestic, social issue that can be isolated from foreign-policy concern.
Its ailing health care system, its aspiration to be seen as a “responsible state,” and international demands for health cooperation have compelled China to be more proactive in the global health domain. There are signs that China is now using public health as a means to strengthen its diplomatic relations with the developing world, in particular the African continent. While China has embraced multilateral cooperation in a wide array of global health issues, its engagement remains “state centric” and therefore leaders attach primary significance to intergovernmental organisations, particularly the UN agencies.
Following the Chinese government's acknowledgement of a SARS outbreak in the country, it began to acknowledge the importance of public health to national development and to accordingly strengthen its multilateral cooperation in combating contagious diseases inside and beyond its borders. For example, in the midst of the recent global economic downturn, the Chinese government announced in 2009 an injection of 850 billion yuan (US$125 billion) into its health care system to improve its operation. Since the SARS outbreak, it has not only deepened its engagement with other nations and international organisations, and cooperated with a variety of actors in dealing with its own fledgling health care system including the problem of HIV/AIDS, but China has also developed a vision for global health diplomacy. A ground-breaking implication of the SARS outbreak for China is that it was struck to realise that public health is not simply a domestic, social issue that can be isolated from foreign-policy and security concerns. In a globalising world, the Chinese government appears to have learned that its health policy will be scrutinised by the world, and hence, it has become more open to and actively participates in global health governance. The government is now learning from such European countries as the UK, France, and Switzerland in the provision of the global public goods for health. Its substantial health assistance to sub-Saharan Africa in building hospitals and training health practitioners forms part of its health diplomacy and contribution to global health governance. It has also been proactively engaging with both regional and global health institutions since 2003 and set up different health surveillance networks with its ASEAN partners as well as other intergovernmental organisations, such as the Asia-Pacific Economic Cooperation (APEC) forum .
Despite its increasing engagement with global health governance since the SARS outbreak, China's approach remains, however, fundamentally state-centric, contrary to the essence of global health diplomacy and governance. With grave concern about the loss of national sovereignty to external or nongovernmental actors, Chinese senior leaders have therefore attached primary significance to intergovernmental organisations, particularly the UN agencies. In evaluating the impact of SARS, Andrew Price-Smith has put the same point succinctly: “while the SARS epidemic may have generated moderate institutional change at the domestic level …, it resulted in only ephemeral change at the level of global governance”. In other words, national sovereignty is still of paramount importance for the Chinese leadership. Because of its sensitivity to foreign interference into its internal affairs, the Chinese government has not yet formally or officially endorsed the notion of “human security.” Under the umbrella concept of national security, “human safety,” instead of “human security,” is discussed throughout all of China's five white papers on national defence since 2000 (i.e., 2000, 2002, 2004, 2006, and 2008). Taiwan's participation in the World Health Assembly is predicated on the condition that it is considered part of China, not an independent entity. Having no tolerance in ceding its supreme authority, the central government has adopted a multi-faceted attitude towards its civil society organisations. While Beijing shows its willingness to cooperate with a wide array of actors inside China, it refuses to let its domestic NGOs and activists establish direct links with their counterparts overseas.
It is still uncertain whether this sovereign concern will trump the provision of global public good for health. Nevertheless, in a highly globalizing world, infectious diseases know no border. While China is seeking to adhere as much as possible to the underlying norms and rules of global health governance (and sometimes even applies them to their extremes), as evidenced by its handling of the recent swine flu outbreak, the major step forward is perhaps to reframe health as a global public good that is available to each and every individual of the world, rather than merely as an issue of concern to nation-states.
Source: PLOS Medicine

Shanghai medics win award for liver cancer research

A Shanghai medical research team received a prize at a high-profile science and technology award ceremony in Beijing this morning in recognition of their innovative treatment of liver cancer.
The team, led by Wu Mengchao, world-renowned liver surgeon with the Shanghai Eastern Hepatobiliary Surgery Hospital, has made breakthroughs in liver cancer research.
For the first time, a team innovation award was created for the National Science and Technology Awards to honor Wu's team.
A total of 337 research projects received the national awards this year and 51 of them were headed by Shanghai professionals, the report said.
This year's top science and technology award went to two veteran academicians of the Chinese Academy of Engineering, Zheng Zhemin, 89, and Wang Xiaomo, 75. Wang is from Shanghai.
It is also the first time for the national government to confer the nation's top science and technology awards to military equipment specialists, China Radio International reported.
Source: Shanghai Daily

Chinese whistleblower sues Siemens after being sacked for revealing hospital bribes

Siemens AG, Europe’s largest engineering company, has been sued by a former compliance officer in its China unit who claimed he was fired after exposing evidence of hospital kickbacks.
Meng-Lin Liu filed a whistle-blower complaint in Manhattan federal court today, claiming he uncovered a scheme in which Siemens Ltd. China submitted inflated bids to sell medical diagnostic and scanning equipment to public hospitals in China and North Korea, and then sold the equipment at reduced prices to intermediaries that charged the hospitals the full bid price.
“This had all of the hallmarks of a classic bribery or ‘kickback’ scheme and there was no legitimate explanation for the huge price differentials that existed between the prices at which Siemens sold the equipment and the prices paid by the end- user hospitals,” Liu claimed in the complaint.
Liu, who said he was hired by Siemens in March 2008, claims he was fired after presenting evidence of the scheme to Siemens China’s chief financial officer for health care. He’s seeking unspecified damages.
Alexander Becker, a spokesman for Munich-based Siemens, declined to comment on the allegations in Liu’s suit.
In 2008, Siemens paid $1.6 billion to settle bribery investigations by U.S. and German authorities.
Source: Bloomberg

Bowel cancer to increase by a million cases in next decade - report

Significant population growth combined with lifestyle changes and increased awareness of the disease will result in a dramatic increase in prevalent cases of colorectal cancer in China over the next decade, according to a new report.
The company’s latest epidemiology report forecasts prevalent CRC cases in China to jump from just under 2 million cases in 2012 to 3.3 million cases by 2022 – an increase of 65% in only 10 years.
China’s above-average population growth will be the primary driver for this worrying increase in CRC prevalence, but shifting living standards and improving healthcare awareness are also important contributors, as this increases the likelihood of sufferers being correctly diagnosed with the disease. According to the report, the incidence of CRC in China increased from about 30 cases per 100,000 people per year in 1988 to about 50 cases per 100,000 people in 2002.
Source: GlobalData

Four influenza deaths reported in Beijing

Four people were killed by influenza within two weeks in Beijing, according to the city's disease control authorities.
From Dec. 31, 2012 to Jan. 13, 2013, three were reported dead from A/H1N1 flu, and another person died of ordinary flu, said a statement issued by the city's disease control and prevention center on Thursday.
Pang Xinghuo, deputy director with the center, said the A/H1N1 and A/H3N2 viruses are spreading in Beijing, with more flu cases expected in the coming days.
Pang advised residents, especially the elderly, children and chronic disease sufferers, to prevent from flu by washing hands more frequently and staying in open air while in public places.
The Ministry of Health said last week the flu season that started in China's northern provinces in December is expected to peak with infections in the next few weeks.

SARS ten years later - The Peking Duck

Incredibly enough, it’s now nearly ten years since SARS became an international crisis and turned much of China inside out.
SARS affected my impressions of China more than any other issue and shaped the tone of this blog for years. Below are my recollections of this turbulent time.

Life and
It was the winter of 2002 and I was having a difficult time in Beijing. I was wondering whether I wanted to live there at all. On my first night in my new apartment I lay down on the bed and it collapsed onto the floor with a crash. As it got colder my central heating only worked about half the time. Sometimes I slept in an overcoat. I had to send part of my salary back to the US to pay for my mortgage and soon learned the bank simply wouldn’t let me. The government wanted to keep all the renminbi in China. And I wasn’t quite prepared for the culture shock of rampant line-cutting, drivers who saw pedestrians as moving targets, questionable sanitation practices and worse.
Read more: Peking Duck

One in six Chinese people have food poisoning every year

New food safety regulations are in place in China, but the problem lies in enforcing them
by Dr Yongning Wu, Key Laboratory of Food Safety Risk Assessment, Ministry of Health and China National Center for Food Safety Risk Assessment, Beijing

Food safety  has become one of the most challenging social issues in China that needs to be addressed.
Domestic issues concerning food safety occur more frequently in China than in other countries; there are loopholes in all the aspects of the food chain—from the farm to the table; public concerns over food safety are growing. A severe scandal related to food safety was recently exposed with regards to the production and extensive use of banned cooking oil which shows that China faces a grave situation in ensuring food safety. In contrast with the different major food safety issues in developed countries, China is dealing with recurrent instances of foodborne diseases, not due to micro-organisms or environmental pollutants, but due to the illegal use of pesticides and veterinary drugs as well as adulterated materials.

In October 2011, the China National Center for Food Safety Risk Assessment was established; it is responsible for risk surveillance, risk assessment, early warning and risk communication, as well as scientific support for national food safety standards. This is the first professional body that aims to offer national-level risk assessment to policy makers and the public, and is one of the few interdepartmental centres in the world, indicating an important step by the Chinese government to strengthen food safety capability building. In June 2012, the State Council issued the 12th Five Year Plan for the National Food Safety Regulation System, highlighting the Chinese government's efforts towards food safety. The plan pointed out that the government needed to comprehensively promote the development of the system in 10 areas: regulations and standards, monitoring and assessment, inspection, process control, supervision of the import and export, food safety, emergency management, comprehensive coordination, science and technology support for research and development, food safety information integrity and missionary training. Key projects will be built that aim to address the urgent outstanding issues with the weak link of the food safety regulatory system need, including food safety risk assessment, the traceability system and the national food safety information exchange platform. In future, China will still need to strengthen development and application of new technologies such as the exposome characterisation of hazards occurring in Chinese food, and particularly risk-benefit techniques for exposure assessment and translational toxicology, to provide technological support for the food safety basic research programme.
As in other countries, although the main problem lies in enforcing food-safety regulations, the largest food safety issues in China are still foodborne diseases, most of which are characterised by acute gastrointestinal illness (AGI). There is a lack of practical means to ensure the implementation of foodborne disease surveillance system improvement. Since only a few cases with AGI seek medical care or submit a specimen for laboratory testing which is then not routinely cultured for pathogens, the true burden of foodborne diseases in China is not clear. During 2010 and 2011, the Center for Food Safety Risk Assessment launched the foodborne diseases active surveillance pilot work in some provinces in China, and the results highlight the substantial burden of AGI cases. It is estimated that there were 202 million cases of foodborne disease in China in 1 year, which means that about 1 in 6.6 people experienced at least one episode of foodborne disease annually (unpublished data). China also needs to establish a foodborne disease active surveillance and traceability system from patients about food-originated pathogens by laboratory-based PULSENET (ChinaFoodNet). One objective is to enhance the ability to deal with emergencies like the outbreak of Escherichia coli O104:H4 in Germany. The rapid expansion of swine production and its potential role as a source of plasmid-mediated quinolone resistance (PMQR) genes in the environment highlights the importance of international co-operation to promote the prudent use of antibiotics in medical therapy, agriculture and animal hus­bandry, and supports the need for effective treatment of husbandry wastewater before its release into the environment. Our results imply that the corre­lation of PMQR genes between wastewater and paired farm soil is a valuable first step in the environmental risk assessment of PMQR genes, but further research is needed to better understand transfer mechanisms. We also recommend the establishment of programmes to monitor antibiotic resistance genes in the envi­ronment on a global scale in order to clarify the extent of potential risks to public health.
The common challenges faced by the world, such as environmental degradation and global foodborne disease outbreaks, together with the food safety issues manifested at the particular social stage of development, constitute the theme of food safety in China. Besides those listed above, there are many reasons for concern about food safety in China and for informing the public that the government is actively addressing these issues. There is still a lot of work to be done to solve the food safety problems in China and to address people's concerns.
Read the full article (subscription only): Journal of Epidemiology and Community Health

Patients turn to loan sharks for money to pay medical bills

Zhou Weijie will never forget the date Aug 26, 2010. While the 21-year-old law student from Anhui University of Technology was crossing the street late that afternoon, a taxi knocked him down and he became unconscious.
In the following months, Zhou underwent one treatment after another, and the hospital bills piled up to 200,000 yuan ($32,000), until he came out of his coma.
Although Zhou got back his life, he was paralyzed below the waist.
Zhou says his parents borrowed 150,000 yuan from a loan shark to pay the medical bills.
As it was a hit-and-run case, the family could not claim compensation from the taxi driver.
Insurance company also rejected their claims because of the lack of legal proceedings.
During the family's most desperate moments, Gao Guangliang - Zhou's law professor, who is also a partner with a legal aid center in Ma'anshan city in Anhui province - came forward to lend a helping hand.
"I visited Zhou and his parents soon after the accident and asked whether they needed free legal support. I reckoned the family must be going through a hard time, both emotionally and financially," Gao says.
His center provides free legal assistance to those involved in a legal case, but cannot afford to hire a lawyer. Among their target clients are teenagers, migrant workers and people with disabilities.
With Gao's assistance, the local traffic department managed to find the taxi driver and claim part of the medical expenses from insurance company.
In April 2011, eight months after the accident, the case was brought before the court. Zhou and his family received 927,648 yuan ($150,000) of compensation in total.
"We successfully won the case, but the money is just a small compensation for Zhou," Gao says.
Both Gao and the legal aid center in Ma'anshan receive funding from the China Legal Aid Foundation, established by the Ministry of Justice in 2009, which provides legal support for the elderly, women, children, people with disabilities and migrant workers.
During the past years, the center has provided free legal assistance to 170,000 people involved in 100,000 cases.
"We have several main methods of reaching out to those in need of help, such as cooperating with legal aid centers in cities and NGOs," says Zheng Xiaze, secretary-general of the foundation.
He says during the past years, their largest group of clients has been migrant workers, as the number of people leaving their home villages to work in cities soars.
For Zhou Weijie, the life-changing accident changed his outlook on life and he is now clearer about his vocation.
"Before the accident, my goal was to study hard and get into a law graduate school," says Zhou, who has been dependent on his wheelchair for more than two years now.
"Now, I think it is more important to put what I have learned to help those in need. I used to think that only the disadvantaged need free legal aid. But I realize from my case that everyone of us can become vulnerable."
Zhou plans to join the legal aid center in the future to pay it forward
Source: China Daily

Thursday, 17 January 2013

Chinese doctors prescribe antibiotics instead of rehydration treatments for diarrhoea

Most patients with diarrhoea were given inappropriate antibiotics when they should have received oral rehydration solution
by Michael Woodhead
In Chinese hospitals, patients presenting with diarrhoea are given inappropriate antibiotics and IV infusions rather than the simple oral rehydration therapies recommended in 'best practice' guidelines, and mismanagement  is much worse in rural areas, a study has found.
Researchers from the Department of Infectious Diseases at Peking University First Hospital assessed adherence by tertiary hospital physicians to national guidelines and World Gastroenterology Organization guidelines for the management of acute diarrhea in adults. The findings suggest nationwide education and effective health policies are needed to improve medical practice and reduce the unnecessary burden on the healthcare system.
Their survey was carried out among physicians and 800 patients in 20 hospitals in Beijing and Shaanxi. Data were collected for 800 patients.
The researchers found that 31% of patients with diarrhoea self-medicated before visiting the clinic, most commonly with antibiotics. The mean interval between the onset of acute
diarrhoea and going to a specialist hospital diarrhea clinic was 2.4 days.
In hospital, routine stool examinations were ordered for 70% of patients, vibrio cholera stool culture for 57%, and non-vibrio bacteria stool culture for only 11%.
Only 62% of patients received the recommended fluid and electrolyte therapy and only 28% received oral rehydration solution. In contrast, 33% of patients were given IV fluids even though only 14% needed it.
Antibiotics were the most common drugs (61%) used and the most common antibiotics were fluoroquinolones, followed by aminoglycosides. In total 51% of patients received irrational antibiotic treatment (unnecessary for 48%; indicated but not prescribed for 3%).
Poor adherence to best practice guidelines was more common in Shaanxi compared with Beijing -  fewer individuals received oral rehydration (8% vs 49% respectively) and more received intravenous fluids (46% vs 21%, respectively). More of the patients in Shaanxi province were given antibiotics (65% vs 57%, respectively), and more received IV antibiotics than Beijing (49% vs 27%).
The researchers conclude: "tertiary hospital physicians in China do not adhere well to [international] guidelines or to national guidelines for the management of acute diarrhea. These findings suggest that nationwide education and effective health policies are needed to improve medical practice and reduce the unnecessary burden on the healthcare system.
Source: BMC Public Health

UK-China partnership launched on global health

The UK and Chinese Governments are working together to improve global health policy and outcomes for developing countries, with the launch in Beijing of a new UK-China partnership on global health.
The UK and Chinese Governments will collaborate under a new initiative, the Global Health Support Programme. The programme will build capacity for DFID and low income countries to learn lessons from China’s unparalleled success in reducing infant, child and maternal mortality rates, disease prevention and control, and China’s health development and health sector reform. The programme will also help to improve China’s capacity to contribute to global health. The programme will run until September 2017, with a UK investment of £12 million to provide a technical contribution and implementation support, and a Chinese contribution of health expertise and facilities. The Ministry of Health’s Centre for Project Supervision and Management will provide programme management. The programme sits under the Memorandum of Understanding signed in 2011 by the British and the Chinese Governments, which established a new partnership to work together on shared international development objectives to reduce poverty and achieve the Millennium Development Goals. This is the third programme launched under the partnership. The new programme will support pilot partnerships between the UK, China and developing countries. The pilots will seek to strengthen health systems and improve health outcomes in developing countries. The programme will include a high-level annual dialogue between China and the UK to work collaboratively on issues of common interest in global health governance and architecture and international health priorities. The programme was launched by Dr. Yin Li, Chinese Vice Minister of Health, Ms. Joy Hutcheon, Director General of the UK Department for International Development and Deputy Director General Sun Yuanjiang of the Ministry of Commerce. Around 120 people attended the launch. “With the progress of globalization, all the countries should work together to respond to global health security and development issues,” said Dr Yin Li, Chinese Vice Minister of Health, “the launch of China-UK Global Health Support Programme ushers the China-UK cooperation into a new stage and also provides a major opportunity for China to play a more significant role in global health affairs.” “The Global Health Support Programme demonstrates the common interest of China and the UK in contributing to improved health outcomes for the poor,” said Ms Hutcheon, “and provides a platform for our two countries to develop common solutions to global issues.” Health outcomes for poor people across the world are under pressure from the dual burden of communicable and non-communicable disease, demographic change, urbanisation and new infectious diseases. China is already an important contributor to global health efforts, and as a board member of the WHO and the Global Fund to Fight HIV/AIDS, TB and Malaria. The launch of the Global Health Support Programme demonstrates China and the UK’s shared commitment to strengthen further global health through innovation and collaboration.