Overall obesity is leveling-off while abdominal obesity continues to rise in a Chinese population experiencing rapid economic development: analysis of serial cross-sectional health survey data 2002-2010.

BACKGROUND: Obesity epidemic is related to industrialization and urbanization that have lead to changes in nutrition, lifestyle and socio-economic status. However, information on the trajectory of the obesity epidemic in populations experiencing rapid economic development is limited. We therefore investigate trends in obesity from 2002 to 2010 in a southern Chinese population experiencing world's fastest economic development. METHODS: Between 2002 and 2010 four standardized surveys were conducted in a population of 85 million residents in Guangdong, China. Multistage cluster sampling was adopted to recruit representative samples. Weight, height and waist circumference of the participants were measured in a standardized way. The analysis included residents aged between 18 and 69 years. The number of participants included in the present analysis for Surveys conducted in 2002, 2004, 2007 and 2010 were 13058, 7646, 6441 and 8575, respectively. RESULTS: From year 2002 to 2010, the age-standardized Body mass index (BMI) insignificantly changed from 21.7 kg m(-2) to 22.3 kg m(-2), and the prevalence of overweight and overall obesity from 15.8 to 16.6% (both P>0.05). The age-standardized waist circumference increased from 73.7 to 78.4 cm, and prevalence of abdominal obesity increased from 12.9 to 23.7% (both P<0.001). In urban areas, BMI and overall obesity changed little during the 8-year period (BMI increased from 22.6 to 22.7 kg m(-2) and overall obesity changed from 23.7 to 21.4%), whereas there were slight increases of the same in rural areas (BMI increased from 20.8 to 22.1 kg m(-2)and overall obesity increased from 8.2 to 13.3%). Waist circumference and abdominal obesity increased significantly in both areas, but the increase was more pronounced in rural areas (in urban area, waist circumference increased from 75.1 to 78.5 cm and abdominal obesity from 16.8 to 26.5%; in rural area, waist circumference from 72.2 to 78.3 and abdominal obesity from 8.8 to 22.0%). CONCLUSIONS: BMI and overall obesity in this population, which has experienced the world's fastest economic development over the past three decades, has been leveling-off, while waist circumference and abdominal obesity, independent predictors of cardiovascular risk, have continued to rise. Our findings suggest that obesity epidemic transition in rapidly developing populations may be much faster than what has been observed in Western countries.

Defining migration and its health impact in China.

The scale and rapid expansion of urbanization resulting from socio-economic transformation in China at the beginning of the 21st century has accelerated rural-urban migration. Public health concerns from this increasing internal population mobility are now receiving attention from researchers. The health problems from internal migration pose particular demands on healthcare systems and relate to its demographic characteristics, with many younger and older people being left behind in the rural countryside. A review of literature, census, policy reports, government documents and media was undertaken to look at the classification system and health characteristics of China's internal migrants. It suggests that public health bears the consequences of political and economic decisions made elsewhere in society.

Pathological Internet use and associated factors among university students in Hong Kong.

1. Among university entrants, the prevalence of pathological Internet use (PIU) increased more than three-fold (from 5.0 to 15.7%) after 18 months of university life. Psycho-social factors such as depression, life dissatisfaction, and use of the Internet for recreational purposes were associated with the development of PIU. 2. University health workers should be aware that PIU is associated with inferior mental well-being, increased sleeping disorders, and deterioration of family relationships. Special attention should be given to Mainland Chinese students and those with pre-existing psychological problems, as they are more prone to developing PIU. 3. Most university students with PIU were unaware of the health implications of the condition and thus not motivated to seek help. Health workers must take a pro-active approach.

Discontinuation of angiotensin-converting enzyme inhibitors: a cohort study.

WHAT IS KNOWN AND OBJECTIVE: Angiotensin-converting enzyme inhibitors (ACEI) are among the most commonly used antihypertensive agents worldwide. Factors associated with their discontinuation in clinical practice are not well defined as studies undertaken in different ethnic populations have yielded conflicting result. We aimed to identify predictors of ACEI discontinuation among Chinese patients. METHODS: We used a validated clinical database for this cohort study. We included all adult patients aged ≥ 18 years who visited any primary care clinic in one Territory of Hong Kong and who were prescribed an ACEI from January 2004 to June 2007. The cumulative incidence of discontinuation 180 days after prescription of an ACEI was measured. Factors associated with discontinuation were evaluated by multiple regression analyses. RESULTS: Among 9398 eligible patients, 14·0% discontinued their prescriptions. After controlling for patient's age, gender, socio-economic status, service type, district of residence, visit type and number of comorbidities, patients aged 70 or above [adjusted odds ratio (AOR) = 1·27, 95% CI 1·04-1·56, P = 0·022], male subjects (AOR = 1·21, 95% CI 1·05-1·40, P = 0·008), new visitors (AOR = 0·64, 95% CI 0·55-0·75, P < 0·001), patients who obtained their prescriptions in Family Medicine Specialist Clinic (FMSC) (AOR = 1·43, 95% CI 1·14-1·79, P = 0·002), patients who lived in the less urbanized district (AOR = 1·96, 95% CI 1·55-2·48, P < 0·001) and the most rural district (AOR = 1·24, 95% CI 1·03-1·49, P = 0·027), and patients with no comorbidity, were more likely to discontinue their medications. WHAT IS NEW AND CONCLUSION: Physicians should pay attention to adherence problems particularly when prescribing ACEI to male patients, those who are older than 70 years, have no comorbidity, live in less urbanized or more rural areas, qualify for fee-waiver, are new attendees of consultations or obtain their ACEI prescriptions in FMSC. Future research should evaluate the reasons for ACEI discontinuation among these higher-risk groups.

Exploring predictors influencing intended and actual acceptability of the A/H1N1 pandemic vaccine: a cohort study of university students in Hong Kong.

OBJECTIVES: To investigate the factors associated with the uptake of influenza A/H1N1 vaccination by university students, and to examine the relationship between intention and actual vaccination. STUDY DESIGN: Prospective cohort study. METHODS: A baseline survey was conducted among students at the Chinese University of Hong Kong in 2009 to collect data on demographics, pandemic risk perceptions and self-reported intention to be vaccinated in the future. A follow-up survey was conducted in 2011 using an online survey platform collecting information on actual vaccine uptake behaviour, and vaccine attitudes, knowledge and perceptions. RESULTS: Self-reported intention to be vaccinated in 2009 was significantly associated with actual vaccine acceptance. Vaccine perceptions (attitudes and knowledge) were found to be a better predictor of vaccine acceptance than disease risk perceptions. Being a medical or science student and receiving health advice about vaccination from a doctor or school-endorsed advertisement were also found to be predictors of vaccine acceptance. CONCLUSIONS: University students in Hong Kong were wary of the A/H1N1 vaccination campaign, as revealed by their low uptake rate and doubts about the vaccine. Knowledge of the pandemic and vaccine was high in this population, but feelings of susceptibility were low. The results indicate a need to provide tailored messages emphasizing the importance of vaccination and the efficacy of the vaccine in the future.

Adherence to lipid-lowering agents among 11,042 patients in clinical practice.

AIMS: Dyslipidaemia is a poorly-controlled condition in clinical practice largely because of poor adherence to medication regimens by patients. This study evaluated the levels of and factors associated with adherence to lipid-lowering agents in a large Chinese population. METHODS: From a validated clinical database, we included all patients who attended any public, primary care clinics in one large Territory of Hong Kong for medication refill at least twice during the study period January 2004 to June 2007. The major outcome variable was Medication Possession Ratio (MPR), an internationally-recognised metric to measure drug adherence. The factors associated with optimal drug adherence (MPR ≥ 0.8) were evaluated by multivariate regression analysis. RESULTS: From 11,042 eligible patients, 90% were adherent. After adjusting for patients' age, gender, socioeconomic status, service type, district of residence, visit type (new visits vs. follow-up visits), the number of comorbidities and the drug class (statin vs. fibrates), older patients [aged 50-59 years; adjusted odds ratio (AOR) 1.30, p = 0.009; 60-69 years; AOR 1.53, p < 0.001; ≥ 70 years; AOR 1.72, p < 0.001], attendance in family medicine specialist clinics (FMSC; AOR 1.56, p < 0.001), follow-up visits (AOR 2.93, p < 0.001) and the presence of comorbidities (one comorbidity; AOR 1.45, p < 0.001; ≥ 2 comorbidities; AOR 1.56, p < 0.001) were associated with optimal drug adherence. DISCUSSION AND CONCLUSION: These findings carry an implication that younger subjects, new patients, visitors in clinics other than FMSC and those without comorbidities should receive more meticulous monitoring of their medication-taking behaviour. Future studies should evaluate the major reasons for non-adherence among them.

Factors associated with compliance to thiazide diuretics among 8551 Chinese patients.

WHAT IS KNOWN AND OBJECTIVE: Good compliance to anti-hypertensive medications has been recognized as a crucial factor to achieve optimal blood pressure control, but there were few studies addressing this issue among ethnic Chinese patients. This study aims to evaluate the factors associated with compliance to thiazide diuretics in a Chinese hypertensive population. METHODS: From a clinical database, all adult Chinese patients aged ≥ 18 years who were prescribed a thiazide diuretic from the public health care sector in one large Territory of Hong Kong during January 2004 to June 2007 and attended at least twice for anti-hypertensive drug refill were included. Medication Possession Ratios were used to measure drug compliance for each patient, with a level ≥ 80% defined as compliant. We used binary logistic regression analysis to evaluate the factors associated with good compliance. RESULTS AND DISCUSSION: From 8551 eligible patients, 84·5% were compliant (defined as MPR ≥ 80%). Fee payers (adjusted odds ratio [aOR] 1·28; 95% CI 1·12-1·46, P < 0·001) and follow-up visitors (aOR 2·47, 95% CI 2·13-2·87, P < 0·001) were significantly associated with better anti-hypertensive compliance. Patients who were newly prescribed thiazide diuretics and those with poorer socioeconomic status were more likely to be non-compliant to anti-hypertensive therapies. Patients' age, gender and number of co-morbidities were not significant associated factors. WHAT IS NEW AND CONCLUSION: Among Chinese patients, those who were newly prescribed thiazide diuretics and those with poorer socioeconomic status were more likely to be non-compliant to anti-hypertensive therapies. Closer monitoring and more intensive compliance-enhancing strategies had to be targeted towards these patients to enhance clinical outcomes.

From economic development to public health improvement: China faces equity challenges.

In the past three decades China has been going through a period of rapid economic growth, which has had profound repercussions for the nation's public health system. Prior to the current health reforms much of the population was left uninsured and facing high financial risk from inadequate healthcare, with especially deep divisions between the urban and rural populations, which continues to pose a huge challenge to health equity and social justice. This paper explores the relationship between economic development and public health and discusses a series of health disparity issues that are emerging in China. These include: (1) health risk and access to care issues among unregistered urban populations (i.e. migrants); (2) low recognition of mental health, and the stigma associated with people with mental illness or communicable disease; and (3) challenges to the traditional system of family care for the elderly, as younger generations migrate to the cities and the remaining rural population ages. Implications for government policy and action to address these issues and improve public health as well as equity are discussed.

Public health services in Shenzhen: a case study.

As one of the fastest growing cities in Pearl River Delta of southern China, Shenzhen accommodates a higher percentage and increasing number of internal migrants, mainly coming from the inland areas. The public health issues that challenge its local government include the special population structure, high incidence of infectious diseases, high prevalence of mental problems, rising chronic disease burdens, and maternal and children's health issues, although progress has been made in the past years. The health authority of Shenzhen has realized that provision of high quality equitable public health services to its residents, including migrants is of high priority, and should be supported by innovations in the health insurance system and establishment of community-based primary care networks. Making changes within the national-level health reform framework and learning from international experiences are necessary and important.

The need for integration in health sciences sets the future direction for public health education.

Since the foundation of the People's Republic of China in 1949, there has been remarkable developments in public health in the country. These achievements are primarily attributed to the public health services and patriotic public health campaigns, although the contribution of high-technology medical applications is also recognized. However, along with the recent socio-economic developments and scientific and technological progress, medical disciplines have become more and more specialized, and clinical and preventive medicine have become further separated from each other. Conventional Chinese wisdom says 'when long divided they must unite, when long united they must divide'. At the onset of the new round of reforms of health care in China, it seems important to revisit the discussions on the urgency for integration of health sciences in medicine in China. Several issues and viewpoints on integrating medicine are discussed in this paper. The biopsychosocial model for health calls for broad integration. Primary care development in China requires integration in education and practice, and in treatment and prevention. Control of chronic diseases requires integrated and united action. Integration of traditional Chinese medicine with Western medicine requires creativity. The integration perspective should be instilled in the minds of medical students. Integration also entails integrated practice. After all, integration entails integrated education and practice in public health education. Changing the current public health education system still has a long way to go. True integration requires integration of concepts, policies, resources and measures, as well as changes in the organization of health care including public health, prevention and treatment. This needs to be a systematic process. Finally, success of integration relies on social mobilization, advocacy, promotion and attention of the entire society.

Literature review of health impact post-earthquakes in China 1906-2007.

BACKGROUND: Over the last 100 years, China has experienced the world's three most fatal earthquakes. The Sichuan Earthquake in May 2008 once again reminded us of the huge human toll geological disaster can lead to. METHODS: In order to learn lessons about the impact of earthquakes on health in China during the past century, we conducted a bilingual literature search of the publicly available health-related disaster databases published between 1906 and 2007. RESULTS: Our search found that research was limited and there were major gaps in the published literature about the impact on health in the post-earthquake period. However, the experiences recorded were similar to those of other parts of the world. The available studies provide useful information about preparedness and rapid early response. Gaps identified included care of chronic disease. CONCLUSION: Our literature review highlights the paucity of literature on the impact on health post-earthquake in China between 1906 and 2007. Disaster mitigation policies need to reflect the needs not only of the disaster-related impacts on health but also of the ongoing health needs of the chronically ill and to establish safeguards for the well-being of the vulnerable populations.

The challenges of public health education with a particular reference to China.

A recent seminar on public health education at the Chinese University of Hong Kong posed some key questions for the future of public health, as well as how the next generation of public health specialists should be educated. This paper summarizes some of the discussions on the future of public health education in China within the context of China's healthcare reforms and trends in global public health education.