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Focuses on the traditional and contemporary medicine incorporated in the health care services in China. Origin of Chinese medicine; Need of the health services of China to deal with the extensive health needs of the country with its large population; Influence of the exposure to the influence of Western nations on the development of modern medical science.

The article focuses on health care and nursing in China. Since the liberation of China in 1949, the health care system and the health status of the people have changed dramatically in the People's Republic of China. The problems that confront nursing in China and present a challenge for the future include the further development of college-level nursing education which has not been available for more than 30 years. During recent years, and especially during the cultural revolution, nurses were prepared without regular nursing school experience.

This paper is based on a comparative study examining how Chinese and white families manage the care of a chronically ill child. The circumstances of their lives that shape their experience of iliness are explored. It is argued that the ideologies which underpin Western health cate practices, in this case, the 'ideology of normalisation', often differ from the perspectives held by non-Western immigrants, and others who do not have access to the ideology. The discrepancies in viewpoints between patients and practitioners can lead to a different set of goals in the treatment encounter, with the possibility of misunderstandings in the clinical context. The 'ideology of normalisation' is used to show how professional ideologies serve as a means of separating out families into those who comply and those who do not. In other words, the ideology, and the moral discourse on normalisation, permit professionals to evaluate families and to categorise them. This categorisation has consequences for patient care, they might be refused treatment. Yet, this ideology is not based merely on 'value-free professional theories', but is located within the moral order. The socio-political, economic and historical factors that underpin the ideology are discussed. [ABSTRACT FROM AUTHOR]

This paper examines interrelationships between health status, access and utilization. Indicators for each of these are measured for China and India. It is shown that China, both during Mao and Deng periods, scores over India in the provision of health services to the rural population. Differences in economic inequalities, organization of health services and motivation account for this. Contrary to the prevailing view there is no conclusive evidence that the post-Mao reforms have lowered the access of rural people to health services. The decline of barefoot doctors has been accompanied by an increase in private medical practitioners, and a decline in rural health insurance has coincided with new and alternative experiments in this domain. [ABSTRACT FROM AUTHOR]

Presents abstracts of several articles on public administration and development. "Health Services and Space Utilisation in Urban and Rural Communities: A Case Study of Ile-Ife, Nigeria"; "Access to Health Services"; "Urban Design Practical in Socialist China."

In order to assess differences that may exist between Western and Asian cancer patients' preferences for information on diagnosis, prognosis, treatment options and involvement in treatment decision-making, a telephone survey of 2674 households explored the preferences for information among the general public in the event they had ‘a cancer-like’ illness. Among these, 1136 people aged between 18–65 years of age were interviewed. Among respondents 95% indicated they would want a diagnosis, even if the news was bad. The same proportion also did not want their family only to be told while they were not so informed. Similarly, 97% of respondents desired a prognosis. While 90% of respondents wanted a discussion on treatment alternatives, 84% felt they should be an equal partner with their doctor, though only 60% wanted to be involved in the treatment decision-making. Multiple regression revealed only age was consistently related to patient preferences, with older patients preferring information and involvement less frequently than younger patients. The patterns of preferences reported here are very similar to those reported in studies on Western populations. [ABSTRACT FROM AUTHOR]

The demand for the evaluation of the quality of patient and client care has increased in public health nursing as in all disciplines of nursing. In Hong Kong this demand led to the development of a collaborative study with the Department of Health to evaluate the quality of public health nursing in the maternal and child health centres. A multiple case study design was developed to undertake the research using both qualitative and quantitative methods of data collection. The findings from the study demonstrated not only implications for clinical practice which have been reported elsewhere, but also methodological issues for the evaluation of care. These findings indicate three major issues for consideration. The first issue is that of the cultural context of care which includes perceptions of care such as demands on the service and expectations of care. The second issue is the use of health data, including both the methods of recording as well as the sources of data. The final issue is that of the method of data collection, in particular the implications of the use of language in data collection tools. The findings suggest that both the use of professional language and the need for translation have implications for data collection methods. Indeed in the author's view the development of methodologies for the evaluation of care must address culturally specific issues, particularly where English is not the first language of subjects in the study. In addition the use the use of language in the method of data collection highlights more general issues raised by the use of translation in the collection and analysis of qualitative data. [ABSTRACT FROM AUTHOR]

There is little information available on strategies of information disclosure used by doctors in the care of patients with cancer. This report focuses on the style of disclosure used by doctors when giving diagnostic and prognostic information to patients with cancer. Among 46% of 133 surgeons and radiotherapists interviewed, disclosure of diagnosis involved a sudden approach (information given outright at one sitting). Less commonly used (19%) was a gradual disclosure style. Of the remainder who disclosed, more than half did so through the family or left it to the family to tell the patient. Doctors’ speciality and patients’ requests for prognostic information dictated disclosure style most frequently. Single people were more likely to have information disclosed to their families than were married people. While anecdotal accounts indicate negative reactions on the part of patients are a major reason for withholding such information, different disclosure style had little effect on doctors’ reports of patient reactions to the bad news. Doctors perceived 25% of patients appeared to react ‘with depression’ but the remaining 75% appeared ‘calm’. These results suggest patients are more likely to be told bad news suddenly, and that doctors do not perceive that this impacts too negatively on patients. The high levels of reported preference for information about cancer in Hong Kong (Fielding and Hung, 1996) conflict with actual prevalence patterns. It seems that commonly cited anecdotal reasons for withholding information from cancer patients in Hong Kong are not sustained by the data produced in these studies. © 1998 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This paper examines how the Chinese state's prenatal health care campaigns of the early 1950s attempted to redefine women's social and political roles. The replacement of local midwifing practices with a uniform birthing method in order to radically reduce infant and mother mortality entailed complex ramifications regarding the relationship of women vis-a-vis the state. Campaigns involved demonizing "traditional" midwifing, promoting a statistical vision of female reproductivity and children as national resources, and the isolation of individual mothers as directly responsible to the state for managing reproduction for the national interest. In sum, a physiological definition of gender was used to open women's bodies to state management. Utopic visions of painless childbirth and of the socialist nation as a giant new family were used to promote participation in grassroots campaigns, but the sources also point to forms of local resistance to the micro-level reorganization of power these campaigns intended. [ABSTRACT FROM AUTHOR]

Discusses the application of professional values in traditional Chinese medicine. Accomplishments of Chinese health care; Medical ethics in China since 1949; Aspects of the efforts to develop professional values in medical practice.

* The significance of primary health care to the health of individuals and communities has been well established but the development of primary health care and nursing practice within the context of primary health care remains varied in different countries and settings.* This paper focuses on developments in nursing practice in primary health care in Hong Kong, using three community-based research projects to identify the opportunities and challenges created for nurses working in these settings. The projects were established in response to identified health needs and to target cancer education, HIV/AIDS and chronic health problems.* Opportunities include the development of professional autonomy, innovative approaches to clinical practice, and developing skills in working with a diverse range of professionals and communities. Challenges include managing uncertainty and the development of evaluation systems to demonstrate health gains from nursing interventions. [ABSTRACT FROM AUTHOR]

Abstract Health is a global concern. Although nursing is a global profession, most schools of nursing concentrate on teaching health exclusively within the context of their own nation. Sister-school partnerships that cross national boundaries are one way of extending the learning opportunities of faculties and students. An example of a 5-year partnership is described and analysed. [ABSTRACT FROM AUTHOR]

Studies the impact of urbanization on rural health care and insurance in China. Data and methods of the study; Results of the study; Conclusions.

Evidence-based practice has been widely discussed in the literature, but it is not common or well adopted in nursing practice, both in Hong Kong and other countries. This article aims to examine the relationships between three important elements of evidence-based practice: systematic reviews, clinical guidelines and protocols. Current issues associated with evidence-based practice in Hong Kong are explored. Specific suggestions are given to researchers, practitioners, managers and academics so that the current situation can be advanced. [ABSTRACT FROM AUTHOR]

woo h. & twinn s. (2004) Journal of Advanced Nursing 45(6), 595–602 Health needs of Hong Kong Chinese pregnant adolescents The outcomes of adolescent pregnancy have been associated with health risks such as obstetric complications and depression, and educational risks such as school dropout and reduced employment opportunities. These outcomes arise from a range of needs including perceived health needs, which are the focus of this paper. This paper reports a study to identify the perceived needs of Hong Kong Chinese adolescents following confirmation of an unintended pregnancy. An exploratory qualitative approach was used with a purposive sample of 10 Hong Kong Chinese pregnant adolescents. The study was undertaken during their stay in a non-government organization maternal shelter. Semi-structured interviews were used to explore adolescents’ perceptions of their psychological, social and health needs and the extent to which each of these needs was met. Six major categories were identified within the context of need, of which three were related to health needs: acceptance of the pregnancy; psychological reactions to the pregnancy; and use of contraception and health advice. The findings contribute to an understanding of the perceived health needs of Chinese adolescents, in particular those that are culturally determined. Implications for nursing practice indicate the significance of comprehensive health assessments and health promotion strategies to help adolescents increase their knowledge about sexual health and contraception. [ABSTRACT FROM AUTHOR]

China has the second greatest number of people suffering from diabetes in the world. The total loss of quality adjusted life years because of diabetes was reported as 8 million years and the amount of health care expenditure spent on diabetes treatment was over 20 billion China dollars. Respondents with higher levels of self-efficacy reported that they were better able to manage their diabetes self-care. This finding lends support to the importance of incorporating the concept of self-efficacy in the design and implementation of diabetes nursing interventions.

The Internet is promising to play a prominent role in health care in the future, but there is an imbalance in its use between the East and the West, between genders, the rich and poor, the educated and uneducated and the urban and rural. This paper looks at the use of the Internet from the perspective of these subgroups across the world, and outlines some of the problems facing disadvantaged groups in particular older people and their caregivers in China. Older people and their predominantly family caregivers have limited access to computers which is compounded by lack of access to good health care. However, it is suggested that this will become a growth area as older people and their caregivers may well bypass traditional care for tele-health care and Internet information-based systems. [ABSTRACT FROM AUTHOR]

This study explored the relationship between three types of living arrangements, namely living alone, living with family, and living in a hostel, and the psychological well-being of older people in Hong Kong. The impact of various sociodemographic factors on the choice of living arrangements of older people was also studied.Ninety healthy Hong Kong Chinese were recruited from four multi-service centres and one hostel. An individual interview was conducted with each participant and the General Health Questionnaire-12 and the Center for Epidemiological Studies Depression Scale-10 were administered.The results suggested that the psychological well-being of older people living in hostels was better than that of older people living alone, but that the psychological well-being of older people living with their family was not different from that of older people living alone.That the psychological well-being of older people in different living arrangements is different may be explained by the differences in time for leisure, access to social services, as well as changes in their attitude towards co-residence with children. [ABSTRACT FROM AUTHOR]

With the promotion and wider acceptance of the concept of ‘normalization’ and ‘community integration’, an increased number of adults with learning disabilities are living in the community and facing more social and health care problems. The authors describe the introduction of new guardianship laws in Hong Kong with the creation of a Guardianship Board to safeguard the interests of all those who are mentally unable to make decisions about their personal, medical or financial affairs. Some case vignettes are provided to illustrate its functions and roles. By sharing the Hong Kong experience, it is hoped that this paper can raise awareness of circumstances in countries that are planning to develop or reform their guardianship practices for people with learning disabilities. [ABSTRACT FROM AUTHOR]

Aim. This paper describes a study identifying the impact of key aspects of Chinese culture on the responses of mid-aged Chinese-Australians to their advanced cancer in order to make recommendations about their care within the health system. Background. Studies conducted in the 1960s and 1970s focused on understanding people's psychological responses to their experiences of terminal illness, but the issue of culture was not addressed. In recent years, a few studies have been conducted with Chinese-Australians, but were limited to issues related to their information needs and the disclosure of a cancer diagnosis. There is a lack of understanding of the impact of Chinese culture on the experiences of these patients. Method. A grounded theory approach was used to generate a substantive theory to explain how mid-aged Chinese-Australians respond to advancing cancer. Eleven participants were recruited and data were collected from face-to-face interviews, telephone contacts, observation and researcher fieldnotes. Data generation occurred between 1997 and 1999. Findings. Four modes of response to advanced cancer were identified: acute crisis, combat, despondency and waiting for death. This paper deals particularly with the combat mode which incorporated five culturally specific strategies used by participants in their struggle against advanced cancer. These were traditional Chinese medicine, traditional Chinese beliefs on the use of food for health maintenance, qi gong (a form of exercise), feng shui (which involves paying attention to spatial organization) and the worship of ancestors and gods. Deeply entrenched within these responses is the influence of Chinese culture, rooted in the beliefs and practices of traditional Chinese medicine and the philosophy of harmony and balance of yin and yang and qi. Conclusion. Healthcare professionals need to be aware of the cultural practices and beliefs of the different ethnic groups for whom they care, and of the importance of accommodation to and negotiation about these cultural practices. [ABSTRACT FROM AUTHOR]

Aim : To describe the rates and patterns of unintentional injuries among primary and middle school students in China. Methods : A cross-sectional survey was conducted in Maanshan City of the Anhui Province in eastern China. All students attending six primary and four middle schools, selected randomly, were asked to report unintentional injuries occurring in the 12-mo period before the survey. The occurrence of unintentional injuries that resulted in medical attendance was summarized by study grade, sex, month and external causes. Results : The annual event-based injury rate per 100 students was higher among boys (21.7) than girls (17.6). Only 1.9% of the episodes resulted in hospitalization, and 17.8% resulted in missing school. The most frequent injuries were falls (38.2%) and transportation-related injuries (19.6%). The risk of injury was lower in middle schools than primary schools. Distribution by month of occurrence showed two peaks in boys during spring and autumn, but no clear peak was observed in girls. Conclusion: The descriptive epidemiology of unintentional injuries among students in China provides useful information on the distributions in person, place and time, which in turn provide hints for the further exploration of possible risk factors that are important in planning strategies for future prevention. [ABSTRACT FROM AUTHOR]

This article outlines the development of China's social assistance programme, including its design, implementation and trends. The Chinese government has given high priority to the establishment and institutionalisation of this programme. To have an effective social assistance programme in the context of an increasingly pluralistic society, China is facing the profoundly challenging task of designing a coherent and over-arching social protection system that would cover retirement, medical care, unemployment and poverty alleviation. [ABSTRACT FROM AUTHOR]

Aim: This paper reports a study that leads to understanding challenges facing nurse educators implementing mandatory continuing nursing education in The People’s Republic of China. Background: Mandatory continuing nursing education was instituted to maintain and develop registered nurses’ competence in the context of healthcare reform in China in 1996. However, there is an increasing complaint of credit-focused and teacher-centred learning in Chinese literature. Despite an increasing appeal to improve the learning situation, little consensus has been reached. By examining nurse educators’ perceived challenges and their coping strategies in implementing mandatory continuing nursing education, this study illuminates the possibilities for reform in mandatory continuing nursing education. Methods: Data were collected through in-depth interactive dialogues between the researcher and five nurse educators in five healthcare organizations in China, utilizing Gadamer’s philosophical hermeneutics. Findings: Three themes were found in this study described as finding a way to support nurses’ competence within a constrained situation, reconciling credit requirements and representing all stakeholders’ interests. Conclusions: A tension between the mandatory continuing nursing education policy and the context of implementing the policy can contribute to credit-focused and teacher-centred learning. Regular policy review and educational support for nurse educators are crucial aspects to improve mandatory continuing nursing education. [ABSTRACT FROM AUTHOR]

Context China has a long tradition of education and medicine. However, limited economic conditions and a huge population mean that further development of medical education in China must be tailored to meet the country's needs. Objectives The aim of this paper is to describe current medical education practice in China with reference to the general and historical purposes of education in China and how they have affected and continue to affect student learning. Reference is also made to both Western medicine and traditional Chinese medicine. Methods It is argued that traditional educational practices in China have encouraged rote learning and that creativity is not cultivated. This affects the way many Chinese students learn medicine. Since 1949, the Chinese medical education system has developed according to its own needs. The current system for training medical students is complex, with medical school curricula lasting 3−8 years. However, medical education reform is taking place and new teaching methods are being introduced in some schools. Discussion Medical education is important to China's large population. The undergraduate medical education system is being streamlined and national standards are being established. Innovations in medical education have recently been encouraged and supported, including the adoption of problem-based learning. It is important that the momentum is kept up so that the health care of a fifth of the world's population is assured. [ABSTRACT FROM AUTHOR]

Aim: To identify the prevalence of breastfeeding initiation and the determinants of the breastfeeding initiation in Xinjiang, PR China, 2003–2004. Methods: A cohort study of infant feeding practices was undertaken in Xinjiang Uygur Autonomous Region, PR China. A total 1219 mothers were randomly recruited in five hospitals or institutes located in urban and rural areas during 2003 and 2004. Multivariate logistic regression analysis was used to explore factors associated with breastfeeding initiation. Results: Before discharge from hospital, 92.2% of the mothers were breastfeeding including 66.2% who were exclusively breastfed. A total of 88 mothers (7.8%) were not breastfeeding on discharge from hospital. Breastfeeding before discharge was positively associated giving breastmilk as the first feed (OR 4.05, CI 1.30–12.65) feeding on demand (OR 4.33, CI 1.69–11.08), when the mother felt she had been given enough information about breastfeeding, belonging to a minority ethnic group (OR 3.13, CI 1.21–5.05) and giving birth in spring or summer. Conclusions: This study has documented breastfeeding initiation rate and associated factors with it in Xinjiang, PR China. [ABSTRACT FROM AUTHOR]

This paper presents research results from the evaluation of the Medical Financial Assistance (MFA) program, supported by the World Bank, to extremely poor rural residents. It is found that MFA can help to improve the ability of the poor to make use of medical services, and especially their ability to receive services from township clinics. The present study also shows that adoption of the MFA mechanism helps to reduce the impact of disease on the economies of poor families, and prevents the poor afflicted with serious illnesses from being marginalized. However, as the beneficiaries often suffer from serious, complicated and lasting illnesses, the financial assistance is often insignificant in relation to medical expenses. Furthermore, the MFA plays no significant role in restoring a patient's income-earning ability. [ABSTRACT FROM AUTHOR]

The author comments on the article published by J. E. Liu. E. Mok and T. Wong entitled "Caring in nursing: investigating the meaning of caring from the perspective of cancer patients in Beijing, China." The author mentions the significant clinical nursing implications of the study and its contribution to improve care practices for Chinese patients. The limitation of the study which lies in the inadequate discussions of the spiritual and cultural issues in Chinese population is included.

Based on a survey conducted by our research team at the Chinese Academy of Social Sciences, the present paper reports on the development of China's new rural cooperative medical system set up in late 2002. The new rural cooperative medical system is different from the old system in that it is organized, guided and supported by the government but that rural residents voluntarily participate in its administration. It is financed by individuals, collectives and the government. The new cooperative medical system focuses on serious disease planning and mutual aid and fraternity between rural residents in health care. The results of our survey indicate that the new rural medical system has been successful up to now but that it also has some problems. China needs to pay more attention to overcoming the difficulties and challenges it faces in terms of future medical needs so that a mechanism for its sustainable development can be established. [ABSTRACT FROM AUTHOR]

Aim. This article is a report of a study of occupational burnout among nurses in China. Background. Burnout is described as feelings of emotional exhaustion, depersonalization and reduced personal accomplishment. It is well-known that burnout is a major problem for many professions. Nurses are considered to be particularly susceptible to this. Measuring burnout among nurses is important because their well-being has implications for stability in the healthcare workforce and for the quality of care provided. Method. The sample consisted of 495 nurses from three provincial hospitals in China. The Maslach Burnout Inventory - General Survey (MBI-GS) was used to measure burnout, and the Occupational Stress Inventory - Revised edition was used to measure two dimensions of occupational adjustment (occupational stress and coping resources). After statistical testing for validity and reliability of the MBI-GS with nurses in China, participants' scores were evaluated and analysed. Results. Scores for burnout of surgical and medical nurses were statistically significantly higher than those of other nurses (P < 0.05). Lower educational status was associated with lower professional efficacy, and younger nurses reported higher levels of burnout. The most significant predictors of emotional exhaustion were role overload, responsibility, role insufficiency and self-care (P < 0.05). The most significant predictors of cynicism were role insufficiency, role boundary, responsibility and self-care (P < 0.05). The most significant predictors of professional efficacy were role insufficiency, social support and rational/cognitive coping (P < 0.05). Conclusion. It is important to reduce occupational stress in nurses and to strengthen their coping resources to prevent burnout. This could be achieved with job redesign, modification of shiftwork systems, and by offering occupational health education. [ABSTRACT FROM AUTHOR]

This article examines the changing demographics of China, with particular attention paid to the effect of the one-child policy in relation to long-term care of older people. It also examines the current state of health care for older people. Long-term stays characterize hospital care. Most geriatric syndromes are less common in hospitalized older people (e.g., delirium, falls), but some (e.g., polypharmacy) are more common. A high volume of patients and brief targeted visits characterize outpatient care. Nursing homes exist in China, but relatively fewer than in the most developed countries. Geriatric departments in university-based hospitals primarily have developed out of a need to care for retired government officials and workers. There are no formal geriatric fellowships or national board certifications in geriatrics Health care is primarily based on fee for service. Not all elderly have healthcare insurance. Although costs of health care and medications are less expensive than in the United States, they are relatively high for lower-and middle-class Chinese and have increased more quickly than has the standard of living in the past 20 years. Family and community support for older people is strong in China. Some older people have one-to-one care from a baomu (literally “protection” ( bao) “mother” ( mu)), a type of live-in maid who also provides care for the older person. Some of the challenges facing China in the care of its aging population are how to increase geriatric research and training, how to care for the uninsured or underinsured, and how to handle the inevitable growth of disabled and frail older people. [ABSTRACT FROM AUTHOR]

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This paper analyzes economic–social interaction in China in connection with the country's change of economic system. I define an economic system in terms of a multi-dimensional vector of broad institutional characteristics, and I emphasize that important features of the social development are closely related to specific changes in these various dimensions. I classify China's options for future social improvements into three broad categories: (i) policies that improve the stability and distribution of factor income; (ii) government-created wedges between factor income and disposable income; and (iii) improvements in the quantity, quality and distribution of human services, such as education and healthcare. [ABSTRACT FROM AUTHOR]

The article presents an overview of the major health issues in China, based on the report of the World Health Organization. The country is facing great challenges on obesity and other related disease control including hypertension, diabetes, and cardiovascular diseases. Study shows that 23% of Chinese people are overweight and 7% are obese, while hypertension in adults increases three times in the past 10 years. Cardiovascular related deaths are projected to increase between 2000 and 2030.

Aims and objectives: The main aim of this study was to identify the coping strategies of stroke caregivers, to identify the factors associated with caregivers' depression and to identify predictors of caregivers' depression. BACKGROUND: Stroke has a high incidence in China. Most stroke survivors are accompanied by family caregivers during hospitalisation. However, little is known about these informal caregivers' coping strategies to the consequences brought on by stroke and their depressive symptoms. METHOD: A correlation and cross-sectional design was used and a purposive sample of 92 stroke survivors and their caregivers completed the questionnaires, which were used to describe the demographic of both the caregiver and stroke survivor, coping strategies (the Brief COPE Inventory) and depression of caregivers (the Center for Epidemiologic Studies Depression Scale). Spearman's correlation and multiple stepwise regression analysis were used in data analyses. RESULTS: Several coping strategies (planning, positive reframing, acceptance, active coping, use of instrumental support and humour) were most commonly used by stroke caregivers. The length of hospital stay, stroke survivor's cognitive status and functional status, family income and coping strategies such as (i) denial, (ii) self-blame, (iii) planning and (iv) religion had significant correlations with caregiver's depression. The best predictors of caregiver's depression were denial, planning and stroke survivor's functional status. CONCLUSIONS: This study contributes to our knowledge about the coping strategies and depression level of stroke caregivers on the Chinese mainland. The depression rate is very high during hospitalisation, although these caregivers often had positive coping responses to the stroke event. Many factors were associated with caregivers' depression. RELEVANCE TO CLINICAL PRACTICE: Nurses should not only pay attention to stroke survivors but also to their caregivers. To help them adjust well from the stroke consequences and avoid depression, nurses should implement effective interventions. [ABSTRACT FROM AUTHOR]

Over the past 20 years, emergency medicine (EM) in China has been through a period of rapid development. This included the formal establishment of professional association of EM in 1986 and the establishment of ED in all county-level hospitals across the country in the late 1990s. In line with the rapid economic development of China, ED have been equipped with appropriate ‘hardware’ equipment, but the ‘software’ part of the ED system remains underdeveloped. Doctors do not usually work exclusively in ED, but on a rotational basis, while also working as specialists in their own departments, such as medicine and surgery. EM in China remains underdeveloped, at least partly, for two main reasons: the current financial status of the health-care system and lack of sufficient numbers of qualified EM specialists. Chinese education and training systems are now beginning to produce high-quality emergency specialists, although there is not yet consistency across all courses. In Australia, the specialty of EM is well developed and, as such, this country is well placed to contribute to the development of ED in China. [ABSTRACT FROM AUTHOR]

Laws in China relating to HIV disclosure are inconsistent. After a patient has tested HIV-positive, service providers struggle to decide who should be informed first: patients, family members, or both. To understand service providers' attitudes and practices regarding the HIV notification process in China, 1101 service providers from a southwestern province of China were surveyed. Opinions were gathered from providers at five different levels of health care facilities (provincial, city, county, township and village). A mixed methods approach was used to analyze perceptions of informing family members of a patient's HIV status. Quantitative analysis was used to examine whether providers held a favorable attitude toward notifying family members first and qualitative analysis was used to explore the reasons and consequences of notifying family members first. Nearly half of service providers felt family members should be informed of a patient's HIV status first. Providers who were older, had contact with HIV patients, or had less medical education were more likely to agree with a family-first notification practice. Psychological pressure, concern about protecting family members, the need for family support, and consideration for local regulations were cited as the main reasons for this practice. There is an immediate need to re-examine HIV notification policies so that there are consistent guidelines and procedures for providers throughout China. [ABSTRACT FROM AUTHOR]

Aims. This paper reviews the role of cardiac nursing in China and the potential of this professional group to take an important role in secondary and tertiary prevention initiatives. Background. China is undergoing unprecedented economic growth, yet globalisation of Chinese society has caused an increase in the prevalence of chronic conditions, particularly cardiovascular disease. Studies recognise that health providers and members of the public are not fully aware of the risks associated with cardiovascular disease and consequently are not equipped to deal with this looming epidemic. Design. Position paper. Method. This position paper summarises and discusses the burden of cardiovascular disease in China within the context of evidence for nurse-coordinated interventions. Barriers and facilitators to developing the nursing role in contemporary China are discussed. Conclusions. A key strategy for promoting the role of nurse-led programmes in China is increasing research skills among Chinese nurses to promote independent, collaborative interdisciplinary research. Promoting doctoral education in China, increasing the status of nursing in interdisciplinary teams, collaborating with cardiovascular nurses internationally and increasing the public's awareness of cardiovascular disease are critical steps in promoting nurse-led programmes to improve the health and well-being of the community. Relevance to clinical practice. Given the positive relationship between knowledge and skill levels of nurses and clinical outcomes, China's investment in the education and training of its nursing workforce is critical in improving practice and outcomes in cardiovascular disease. [ABSTRACT FROM AUTHOR]

The article presents a commentary on the study which reveals a need to enhance the nursing role in improving health outcomes of cardiovascular disease in China. It notes that the authors of the paper did not propose how the obstacles for changes in cardiac nursing will occur in China. Moreover, it asserts that nurses in China should examine the factors that influence nursing philosophy such as role and authority, and researchers should try to investigate in altering some of these factors.

Dividing China into seven regions reveals rural income and consumption divergence for both 1980–2005 and 2000–05. But while real rural consumption growth averaged 7.7 percent over 1985–2005 in the eastern coastal region, it averaged 6.5 percent uniformly in the interior. In evaluating well-being, such rapid improvement in all regions arguably overshadows negative connotations of divergence. Twenty years of household survey data reveal dramatic increases in rural household savings, as rural consumption improved more slowly than income in some periods. This raises questions about the suitability of consumption as a basis for measuring well-being and its distribution. Increased savings appear to be transient, as some households save while others dissave to purchase durables and afford lumpy services like education and healthcare—supplies of which became more plentiful in the 1990s. The paper argues that more meaningful measures of regional disparities come from differences in regional poverty headcounts. It also suggests that higher regional inequality and accompanying interregional migration indicate that inequality plays an important positive role in inducing economic actors voluntarily to move to more productive locations and activities as a mechanism for ensuring sustainable improvements in individual well-being. [ABSTRACT FROM AUTHOR]

Background The next influenza pandemic will create a surge in demand for health resources in China, with its current population of >1·3 billion persons and under-developed medical care and public health system. However, few pandemic impact data are available for China. Objectives We estimated the effects of a future influenza pandemic in China by examining pandemic scenarios of varying severity and described the time distribution of cases during a first wave. Methods  We used a Monte-Carlo simulation model and death rates, hospitalizations and outpatient visits for 1918- and 1968-like pandemic scenarios and data from the literature or experts’ opinion to estimate four health outcomes: deaths, hospitalizations, outpatient medical visits and clinical illness for which medical care was not sought. For each of the two scenarios we estimated outcomes by week using a normal distribution. Results We estimated that a 1968 scenario in China would result in 460 000–700 000 deaths, 1·94–2·27 million hospitalizations, 111–117 million outpatient visits and 192–197 million illnesses for which medical care was not sought. Fifty-two percent of hospitalizations occurred during the two-peak weeks of the first wave. We estimated that patients at high-risk of influenza complications (10–17% of the population) would account for 61–75% of all deaths. For a 1918 scenario, we estimated that 4·95–6·95 million deaths, 20·8–22·7 million hospitalizations and 101–108 million outpatient visits could occur. Conclusion Even a 1968 pandemic scenario will pose substantial challenges for the medical and public health system in China, and planning to manage these challenges is essential. [ABSTRACT FROM AUTHOR]

Objective To describe and analyse factors associated with the duration of disease onset to hospital admission, admission to discharge and admission to death for severe acute respiratory syndrome (SARS), using the recently developed comprehensive database covering all regions of mainland China, and compare the results within and outside China. Methods The database included all probable 5327 SARS cases, of whom 343 died. Linear regression (uni- and multivariate analysis) was performed for all three durations to test the impact of the following variables: sex, age, occupation, geographic location and period of the SARS epidemic (time since the first case, i.e. 16 November 2002). Results The average duration of onset of symptoms to hospital admission was 3.8 days, of admission to discharge for those who survived was 29.7 days, while admission to death for casualties was 17.4 days. Health care workers, patients from Tianjin and patients infected towards the end of the epidemic had the shortest duration of onset to admission. Regarding admission to discharge, particularly young patients and patients from Guangdong had the shortest duration. Older age was the sole factor associated with shorter duration of admission to death. Conclusions The average duration and pattern (with time of epidemic and age) of onset of symptoms to hospital admission of SARS patients in mainland China were comparable to other affected areas. The duration of hospital admission to discharge was shorter than elsewhere, possibly because of different hospitalisation policies. The duration of hospital admission to death in mainland China, however, appeared to be shorter than in other areas, which is in striking contrast to the much lower case fatality in mainland China. [ABSTRACT FROM AUTHOR]

Many factors influence a mother's decision to breastfeed. We investigated whether the melamine scandal involving infant formula influenced the decision to breastfeed. News of the melamine scandal was revealed in September 2008 and rapidly spread via the internet. We illustrate that this scandal significantly and rapidly impacted the pattern of newborn feeding among Chinese women who delivered at a hospital in the eastern district of Paris. This area is home to one of the largest groups of Chinese people in France. The breastfeeding rate increased sharply in September 2008 from 14% to a peak of 31% ( p = 0.014) before decreasing over a 6-month period at a rate slower than the diminishing media frenzy. The effect of the melamine news coverage on the internet was temporary and strongly associated to ethnicity and language ( p = 0.015, p = 0.004, respectively). Numerous patients utilize the internet to access medical information, and these findings highlight the internet's role in the healthcare equation. [ABSTRACT FROM AUTHOR]

The article presents the views expressed by the participants of a roundtable discussion on how to deal with the rising demand for dialysis held during the Second Congress of the International Society for Hemodialysis in Hong Kong, China in August 2009. The conference was attended by academic nephrologists, health care officials, and nephrology society representatives. Focal to the roundtable discussion was dialysis economics and the ways to tackle the dialysis burden around the world.

The current dental curriculum in China was developed from the system in the Soviet Union in the 1950s. This curriculum is outdated and must be reformed to keep pace with the development of modern dental education. The new dental educational system should be customized to China's needs: care for a large population with poor overall oral health, operating within a government-owned, centralized health care delivery system. Chine e research universities have a mission to produce competent dentists who will also be educators and researchers. To efficiently train academic dentists who can al o meet the clinical need of today's Chinese population, a new dental curriculum wa developed at the Institute and Ho pi tal of Dentistry, anjing University Medical School. This curriculum ha four main features: I) a two-year general higher education plu five-year dental education ("2+5") model; 2) improved integration of didactic and practical learning; 3) improved integration of dental education with research training; and 4) improved overall equencing of the entire curriculum. This article de cribe the details ofthi new dental curriculum [ABSTRACT FROM AUTHOR]

A proliferation of health information technology (HIT) policies to implement dimensions of e-health, including electronic medical records, electronic health records, personal health records, and e-prescribing-along with expanding initiatives on mobile health in developed countries and emerging technologies-has sparked academic inquiry into the protection of privacy and data and the technology to protect privacy and data. This article examines HIT policies in the United States and in China and the use of authentication technologies to assess biometrics as privacy's friend or foe in different political frameworks with varying conceptions of privacy. An analysis of privacy in the context of health data protection, challenging relations of trust between patients and providers, the increasing perspective of health data integrity as a cyber-security issue, and the growing rate of medical fraud and medical identity theft may yield findings of a convergence of views of privacy and biometrics unexpected of contrasting political cultures. [ABSTRACT FROM AUTHOR]

Background: To reduce harm caused by health care is a global priority. Medical students should be able to recognize unsafe conditions, systematically report errors, and near misses, investigate and improve such systems with a thorough understanding of human fallibility, and disclose errors to patients. Therefore, incorporating knowledge about patient safety into medical school curriculums is an urgent necessity. Objectives: To describe the extent to which Chinese medical students have patient safety in their knowledge, skills, and attitudes so as to provide evidence for implementation of a patient safety curriculum in medical schools, and to assess the quality of this investigative questionnaire. Methods: Our questionnaire of 31 items was developed based on a 2008 WHO pilot study for a patient safety curriculum guide. Our investigation was conducted in three university medical schools in China. Year 3 and year 4 medical students were asked to complete an anonymous questionnaire in their classroom settings. All items were scored from 1 to 5. Differences in responses among different universities, genders, and levels, as well as the validity and reliability of the questionnaire, were analyzed using SPSS 15.0. Results: A total of 500 questionnaires were distributed, and 143 male and 262 female students completed the survey. An average of 0.96% of survey questions were not answered, of which the most frequently unanswered item was 'what will happen when medical error occurs?' The students' attitudes to learning about patient safety were positive, although their knowledge of medical error and how to report error was poor. There were no statistical differences among different medical schools and levels in any item responses. The only gender difference appeared in the response to 'I would like to discuss with others when I made a medical error.' There was a good coherence of reliability in sections 2, 3, and 4 of the questionnaire (Cronbach's alpha > 0.8), while sections 5 and 6 scored as less reliable. The validity of the questionnaire was good. Conclusions: Although medical students' understanding of patient safety is very poor in China, the students have a positive attitudes to learning about the knowledge of patient safety in their future careers. [ABSTRACT FROM AUTHOR]

ABSTRACT The paper looks in detail at patients that were treated at one of the most discussed companies operating in the field of untried stem cell treatments, Beike Biotech of Shenzhen, China. Our data show that patients who had been treated at Beike Biotech view themselves as proactively pursuing treatment choices that are not available in their home countries. These patients typically come from a broad variety of countries: China, the United Kingdom, the United States, South Africa and Australia. Among the patients we interviewed there seemed to be both an awareness of the general risks involved in such experimental treatments and a readiness to accept those risks weighed against the possible benefits. We interpret this evidence as possibly reflecting the emergence of risk-taking patients as 'consumers' of medical options as well as the drive of patients to seek treatment options in the global arena, rather than being hindered by the ethical and regulatory constraints of their home countries. Further, we found that these patients tend to operate in more or less stable networks and groups in which they interact and cooperate closely and develop opinions and assessments of available treatment options for their ailments. These patients also perform a multiple role as patients, research subjects, and research funders because they are required to pay their way into treatment and research activities. This new social dynamics of patienthood has important implications for the ethical governance of stem cell treatments. [ABSTRACT FROM AUTHOR]

Despite their recent deterioration, village clinics have historically been an important source of health care for the poor and elderly in rural China. In this paper, we examine the current role of village clinics, the patients who use them and some of the services they provide. We focus specifically on the role of village clinics in meeting the health-care needs of the rural poor and elderly. We find that although clinics are continuing to decline financially, they remain a source of care for the rural elderly and poor. We estimate that the elderly are 10-15 percent more likely than young individuals to seek care at a clinic. We show that clinics provide many unique services to support the rural elderly (and the elderly poor), such as in-home patient care, the option for patients to pay on credit, and free and discounted services. [ABSTRACT FROM AUTHOR]