Correspondence
2
3
4
5
Silbermann M. Middle East Cancer Consortium. In: International Innovation. Bristol: Research Media Ltd, 2013: 66–67. Cleary J, Silbermann M, Scholten W, Cherny N. Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in the Middle East. A report from the Global Opioid Policy Initiative (GOPI). Ann Oncol 2013; 24: 51–59. Ben Ari E. Global Collaboration. Considering culture when providing cancer care. NCI Cancer Bull 2010; 7: 23. International Narcotics Control Board. Population: World Health Organization. WHO Collaborating Center for Drug Statistics Methodology, Pain & Policy Group, University of Wisconsin Carbone Cancer Center, Madison, Wisconsin. http://www.painpolicy.wisc.edu (accessed April 7, 2015). Silbermann M, Epner DE, Charalambous H, et al. Promoting new approaches for cancer care in the Middle East. Ann Oncol 2013, 24: 5–10.
I declare no competing interests.
Hong Zhang [email protected]
Cigarette smoking among Chinese medical staff Tobacco smoking among medical staff in China is an important issue. According to a survey 1 done in 7169 male medical students from 16 universities in 12 provinces the proportion of smokers was 910 (12·8%) of 7135. Another survey2 in 992 female medical students from a medical college in the city of Chongqing (Sichuan Province), showed that the proportion of smokers in these women was 34 (3·5%) of 970. Tobacco consumption is the leading cause of preventable diseases and death that physicians face in their professional careers. However, doctors’ smoking behaviour might affect their attitudes towards tobacco control. According to a survey3 in Changzhou (Jiangsu Province), 171 (27·6%) of 620 of doctors were smokers; the proportion of male smokers 168 (27·1%) of 620 was substantially higher than female smokers 3 (0·5%) of 620. Of the surgeons surveyed, almost half were smokers. Additionally, www.thelancet.com Vol 385 April 25, 2015
Department of Neurology, Teaching and Research Department of Neuropsychiatry, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei, China 1
2
3
4
Liu J, Zhang J, Liao J. Analysis of smoking behavior among Chinese male medical students in 16 universities. Chin J Sch Health 2013; 34: 303–06 (in Chinese). Lei C, Xiong H. Survey on smoking and attempting smoking behavior and their influencing factors among female students of a medical college in Chongqing. Chongqing Med 2014; 43: 208–10 (in Chinese). Feng L, Xu C. A survey on cigarette smoking related behavior among medical doctors in Changzhou. Chin Prev Med 2013; 14: 852–56 (in Chinese). Chinese Ministry of Health. China smoking is hazardous to health reports. Chin J Health Educ 2012; 28: 603 (in Chinese).
Dengue fever in China The Lancet Seminar1 by Maria Guzman and Eva Harris on dengue regarded the burden of dengue in China as unknown. However, dengue fever is a notifiable disease in China, and all cases of dengue fever were diagnosed according to the unified diagnostic criteria issued by the National Health and Family Planning Commission, which includes definitions of clinically diagnosed and laboratory-confirmed cases. From 1978 to 2008, a total of 655 324 cases
50 000 45 000
4·0
Cases Incidence rate
3·5
40 000
3·0
35 000
2·5
30 000 Cases
1
141 (22·7%) of 620 doctors never or rarely asked about the smoking habits of their patients and only 355 (57·3%) of 620 doctors encouraged their patients to quit smoking.3 The Chinese Ministry of Health issued a report in 2012 about the dangers that smoking can have on health.4 However, some doctors and medical students are still smoking despite these risks. Therefore, specific health education and training, targeting doctors and medical students, about how to quit smoking is key to reduce this burden. Importantly, medical staff should encourage their patients and the general population to quit smoking too.
25 000
2·0
20 000
1·5
15 000
1·0
10 000
0·5
5000 0
Incidence (per 100 000 people)
(RF-A); Department of Oncology, Tawam Hospital, Al-Ain, Abu Dhabi, United Arab Emirates (MAJ); and Weill Cornell Faculty of Medicine, National Center for Cancer Care and Research, Doha, Qatar (AAH)
2009
2010
2011
2012
2013
2014
0
Year
Figure: Incidence and cases notified of dengue fever (2009–14)
were reported in mainland China, resulting in 610 deaths.2 According to China National Notifiable Disease Surveillance System, from 2009 to 2014, the range of incidence was 0·0091–3·4581 per 100 000 people, and a total of 52 749 cases of dengue fever and six deaths were notified (figure). Because dengue is an emerging disease in China, possible cases are traced by active field investigation when outbreaks occur in the community. Thus, dengue surveillance involves both passive and active case detection. Further study should focus on analysis of prevalence and assessment of relations between seroprevalence and incidence. In 2014, a series of dengue fever outbreaks occurred in Guangdong, Yunnan, Fujian, and Guangxi. These outbreaks pose a substantial socioeconomic burden. Additionally, these outbreaks showed new epidemic trends for dengue fever in Guangdong. Hui and colleagues 3 showed that DENV-2 strains circulating in Guangdong have been stable since their introduction in the 2000s—which challenged the view that dengue fever is an imported epidemic disease.4 We declare no competing interests. We thank the National Basic Research Programme of China and the National Natural Science Foundation of China for support.
Bin Chen, *Qiyong Liu [email protected]
1621
Correspondence
State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention (BC, QL), and China CDC Key Laboratory of Surveillance and Early-Warning on Infectious Disease (BC, QL), Chinese Center for Disease Control and Prevention, Changping, Beijing, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China (BC, QL); and Xiamen Entry-Exit Inspection and Quarantine Bureau, Xiamen, China (BC) 1 2
3
4
Guzman MG, Harris E. Dengue. Lancet 2015; 385: 453–65. Wu JY, Lun ZR, James AA, Chen XG. Dengue fever in mainland China. Am J Trop Med Hyg 2010; 83: 664–71. Zhao H, Zhao L, Jiang T, et al. Isolation and characterization of dengue virus serotype 2 from the large dengue outbreak in Guangdong, China in 2014. Sci China Life Sci 2014; 57: 1149–55. Sang S, Chen B, Wu H, et al. Dengue is still an imported disease in China: a case study in Guangzhou. Infect Genet Evol 2015; 32: 178–90.
Road traffic injury and rescue system in China
Published Online March 26, 2015 http://dx.doi.org/10.1016/ S0140-6736(15)60304-X
Published Online February 6, 2015 http://dx.doi.org/10.1016/ S0140-6736(14)62451-X
1622
Transportation network in China has progressed substantially in the past three decades. There are about 4·35 million kilometres of roads,1 and 264 million vehicles—the second largest number of vehicles after the USA.2 The rapidly increasing number of vehicles, growing number of new drivers, and poor road design with no separation between pedestrians and motor vehicles 3 led to the large number of traffic accidents. 204 200 traffic accidents occurred in China in 2012. 4 The mortality rate of traffic injury was 20·5 per 100 000 people in 2010, which is much higher than that in developed countries (eg, 4·7 per 100 000 in Germany, and 5·2 per 100 000 in Japan), and higher than in Asian developing countries (eg, 18·9 per 100 000 in India and 17·7 per 100 000 in Indonesia).5 Why is the mortality rate of traffic injury so high in China? One of the major problems is China’s traffic injury rescue system. At present, no standard procedures exist for the rescue stage before hospital admission. Poorly trained emergency medical service workers and insufficient
onsite care result in a low success rate of pre-hospital resuscitation. Long transport times, no existing patient-transfer triage system, and incorrect therapy before hospital admission mean that many patients miss out on proper treatment in hospitals. 6 Additionally, hospitals often have to admit several patients with severe traffic injuries without any warning because collaboration and communication between emergency services and hospitals are not effective.7 Improvement of traffic injury rescue in China is urgent. To tackle the challenges of traffic injuries, international trauma life-support training courses should be introduced as soon as possible. Traffic injury information exchange systems between emergency services and hospital admission should be established. During the transition period, qualified general hospitals should be selected as trauma centres in specific areas, dependent on their location and features. The mechanism of effective collaboration among emergency services, emergency departments, and related departments in hospitals needs to be established. Supported by the Chinese Government, Peking University Traffic Medical Center has led research of traffic injury rescue standards in 124 hospitals in 15 cities. Preliminary results show that application of advanced rescue and treatment procedure has significantly reduced fatality and disability of severely injured people.7 We anticipate that the status of Chinese traffic injury rescue can be improved substantially in the near future. We declare no competing interests. We acknowledge support from the Research Special Fund for Public Welfare Industry of Health from the National Health and Family Planning Commission of China.
Tianbing Wang, Xiaofeng Yin, Peixun Zhang, Yuhui Kou, *Baoguo Jiang [email protected] Peking University People’s Hospital and Peking University Traffic Medical Center, 100044 Beijing, China
1
2
3
4
5
6
7
Ministry of Transport of the People’s Republic of China. China transport statistic bullet (in Chinese). 2013. http://www.moc.gov.cn/zfxxgk/ bnssj/zhghs/201405/t20140513_1618277.html (accessed March 25, 2015). Ministry of Public Security of the People’s Republic of China. The sharp increase of vehicles and drivers in China (in Chinese). 2014. http://www.mps.gov.cn/n16/n1252/n1837/ n2557/4330449.html (accessed March 25, 2015). Wang SY, Li YH, Chi GB, et al. Injury-related fatalities in China: an under-recognised publichealth problem. Lancet 2008; 372: 1765–73. National Bureau of Statistics of China. China Statistical Yearbook. China Statistics Press, 2013. http://www.stats.gov.cn/tjsj/ndsj/2013/ indexch.htm (accessed March 25, 2015). WHO. The statistical annexes of the Global status report on road safety 2013. http://www. who.int/violence_injury_prevention/road_ safety_status/2013 (accessed March 25, 2015). Gui L, Gu S, Lu F, Zhou B, Zhang L. Pre-hospital emergency care in Shanghai: present and future. J Emerg Med 2012; 6: 1132–37. Yin XF, Wang TB, Jiang BG, et al. Evaluation of rescue severe trauma injury patients in China by standard procedure. Chin Med J (in press).
Department of Error Lobo MD, Sobotka PA, Stanton A, et al. Central arteriovenous anastomosis for the treatment of patients with uncontrolled hypertension (the ROX CONTROL HTN study): a randomised controlled trial. Lancet 2015; 385: 1634–41— On the fourth page of this Article, the sentence starting on line 5 should read “17 patients (n=10 in the arteriovenous coupler group and n=7 in the control group) had previously undergone renal denervation beyond 6 months of enrolment”, and in the panel Research in context, reference 17 should have been reference 19. These corrections have been made to the online version as of April 24, 2015, and the printed Article is correct. Hersch J, Barratt A, Jansen J, et al. Use of a decision aid including information on overdetection to support informed choice about breast cancer screening: a randomised controlled trial. Lancet 2015; 385: 1642–52—In this Article, the references 19–26 have been corrected. This correction has been made to the online version as of March 26, 2015 and the printed Article is correct. García-Moreno C, Zimmerman C, Morris-Gehring A, et al. Addressing violence against women: a call to action. Lancet 2015; 385: 1685–95—In table 2 of this Series paper, the text in the Indicator column of the Change norms row has been corrected to “More than 50% of women, men, or both believe that some form of violence against women or girls is unacceptable”. This correction has been made to the online version as of Feb 6, 2015, and the printed report is correct.
www.thelancet.com Vol 385 April 25, 2015
2
3
4
5
Silbermann M. Middle East Cancer Consortium. In: International Innovation. Bristol: Research Media Ltd, 2013: 66–67. Cleary J, Silbermann M, Scholten W, Cherny N. Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in the Middle East. A report from the Global Opioid Policy Initiative (GOPI). Ann Oncol 2013; 24: 51–59. Ben Ari E. Global Collaboration. Considering culture when providing cancer care. NCI Cancer Bull 2010; 7: 23. International Narcotics Control Board. Population: World Health Organization. WHO Collaborating Center for Drug Statistics Methodology, Pain & Policy Group, University of Wisconsin Carbone Cancer Center, Madison, Wisconsin. http://www.painpolicy.wisc.edu (accessed April 7, 2015). Silbermann M, Epner DE, Charalambous H, et al. Promoting new approaches for cancer care in the Middle East. Ann Oncol 2013, 24: 5–10.
I declare no competing interests.
Hong Zhang [email protected]
Cigarette smoking among Chinese medical staff Tobacco smoking among medical staff in China is an important issue. According to a survey 1 done in 7169 male medical students from 16 universities in 12 provinces the proportion of smokers was 910 (12·8%) of 7135. Another survey2 in 992 female medical students from a medical college in the city of Chongqing (Sichuan Province), showed that the proportion of smokers in these women was 34 (3·5%) of 970. Tobacco consumption is the leading cause of preventable diseases and death that physicians face in their professional careers. However, doctors’ smoking behaviour might affect their attitudes towards tobacco control. According to a survey3 in Changzhou (Jiangsu Province), 171 (27·6%) of 620 of doctors were smokers; the proportion of male smokers 168 (27·1%) of 620 was substantially higher than female smokers 3 (0·5%) of 620. Of the surgeons surveyed, almost half were smokers. Additionally, www.thelancet.com Vol 385 April 25, 2015
Department of Neurology, Teaching and Research Department of Neuropsychiatry, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei, China 1
2
3
4
Liu J, Zhang J, Liao J. Analysis of smoking behavior among Chinese male medical students in 16 universities. Chin J Sch Health 2013; 34: 303–06 (in Chinese). Lei C, Xiong H. Survey on smoking and attempting smoking behavior and their influencing factors among female students of a medical college in Chongqing. Chongqing Med 2014; 43: 208–10 (in Chinese). Feng L, Xu C. A survey on cigarette smoking related behavior among medical doctors in Changzhou. Chin Prev Med 2013; 14: 852–56 (in Chinese). Chinese Ministry of Health. China smoking is hazardous to health reports. Chin J Health Educ 2012; 28: 603 (in Chinese).
Dengue fever in China The Lancet Seminar1 by Maria Guzman and Eva Harris on dengue regarded the burden of dengue in China as unknown. However, dengue fever is a notifiable disease in China, and all cases of dengue fever were diagnosed according to the unified diagnostic criteria issued by the National Health and Family Planning Commission, which includes definitions of clinically diagnosed and laboratory-confirmed cases. From 1978 to 2008, a total of 655 324 cases
50 000 45 000
4·0
Cases Incidence rate
3·5
40 000
3·0
35 000
2·5
30 000 Cases
1
141 (22·7%) of 620 doctors never or rarely asked about the smoking habits of their patients and only 355 (57·3%) of 620 doctors encouraged their patients to quit smoking.3 The Chinese Ministry of Health issued a report in 2012 about the dangers that smoking can have on health.4 However, some doctors and medical students are still smoking despite these risks. Therefore, specific health education and training, targeting doctors and medical students, about how to quit smoking is key to reduce this burden. Importantly, medical staff should encourage their patients and the general population to quit smoking too.
25 000
2·0
20 000
1·5
15 000
1·0
10 000
0·5
5000 0
Incidence (per 100 000 people)
(RF-A); Department of Oncology, Tawam Hospital, Al-Ain, Abu Dhabi, United Arab Emirates (MAJ); and Weill Cornell Faculty of Medicine, National Center for Cancer Care and Research, Doha, Qatar (AAH)
2009
2010
2011
2012
2013
2014
0
Year
Figure: Incidence and cases notified of dengue fever (2009–14)
were reported in mainland China, resulting in 610 deaths.2 According to China National Notifiable Disease Surveillance System, from 2009 to 2014, the range of incidence was 0·0091–3·4581 per 100 000 people, and a total of 52 749 cases of dengue fever and six deaths were notified (figure). Because dengue is an emerging disease in China, possible cases are traced by active field investigation when outbreaks occur in the community. Thus, dengue surveillance involves both passive and active case detection. Further study should focus on analysis of prevalence and assessment of relations between seroprevalence and incidence. In 2014, a series of dengue fever outbreaks occurred in Guangdong, Yunnan, Fujian, and Guangxi. These outbreaks pose a substantial socioeconomic burden. Additionally, these outbreaks showed new epidemic trends for dengue fever in Guangdong. Hui and colleagues 3 showed that DENV-2 strains circulating in Guangdong have been stable since their introduction in the 2000s—which challenged the view that dengue fever is an imported epidemic disease.4 We declare no competing interests. We thank the National Basic Research Programme of China and the National Natural Science Foundation of China for support.
Bin Chen, *Qiyong Liu [email protected]
1621
Correspondence
State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention (BC, QL), and China CDC Key Laboratory of Surveillance and Early-Warning on Infectious Disease (BC, QL), Chinese Center for Disease Control and Prevention, Changping, Beijing, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China (BC, QL); and Xiamen Entry-Exit Inspection and Quarantine Bureau, Xiamen, China (BC) 1 2
3
4
Guzman MG, Harris E. Dengue. Lancet 2015; 385: 453–65. Wu JY, Lun ZR, James AA, Chen XG. Dengue fever in mainland China. Am J Trop Med Hyg 2010; 83: 664–71. Zhao H, Zhao L, Jiang T, et al. Isolation and characterization of dengue virus serotype 2 from the large dengue outbreak in Guangdong, China in 2014. Sci China Life Sci 2014; 57: 1149–55. Sang S, Chen B, Wu H, et al. Dengue is still an imported disease in China: a case study in Guangzhou. Infect Genet Evol 2015; 32: 178–90.
Road traffic injury and rescue system in China
Published Online March 26, 2015 http://dx.doi.org/10.1016/ S0140-6736(15)60304-X
Published Online February 6, 2015 http://dx.doi.org/10.1016/ S0140-6736(14)62451-X
1622
Transportation network in China has progressed substantially in the past three decades. There are about 4·35 million kilometres of roads,1 and 264 million vehicles—the second largest number of vehicles after the USA.2 The rapidly increasing number of vehicles, growing number of new drivers, and poor road design with no separation between pedestrians and motor vehicles 3 led to the large number of traffic accidents. 204 200 traffic accidents occurred in China in 2012. 4 The mortality rate of traffic injury was 20·5 per 100 000 people in 2010, which is much higher than that in developed countries (eg, 4·7 per 100 000 in Germany, and 5·2 per 100 000 in Japan), and higher than in Asian developing countries (eg, 18·9 per 100 000 in India and 17·7 per 100 000 in Indonesia).5 Why is the mortality rate of traffic injury so high in China? One of the major problems is China’s traffic injury rescue system. At present, no standard procedures exist for the rescue stage before hospital admission. Poorly trained emergency medical service workers and insufficient
onsite care result in a low success rate of pre-hospital resuscitation. Long transport times, no existing patient-transfer triage system, and incorrect therapy before hospital admission mean that many patients miss out on proper treatment in hospitals. 6 Additionally, hospitals often have to admit several patients with severe traffic injuries without any warning because collaboration and communication between emergency services and hospitals are not effective.7 Improvement of traffic injury rescue in China is urgent. To tackle the challenges of traffic injuries, international trauma life-support training courses should be introduced as soon as possible. Traffic injury information exchange systems between emergency services and hospital admission should be established. During the transition period, qualified general hospitals should be selected as trauma centres in specific areas, dependent on their location and features. The mechanism of effective collaboration among emergency services, emergency departments, and related departments in hospitals needs to be established. Supported by the Chinese Government, Peking University Traffic Medical Center has led research of traffic injury rescue standards in 124 hospitals in 15 cities. Preliminary results show that application of advanced rescue and treatment procedure has significantly reduced fatality and disability of severely injured people.7 We anticipate that the status of Chinese traffic injury rescue can be improved substantially in the near future. We declare no competing interests. We acknowledge support from the Research Special Fund for Public Welfare Industry of Health from the National Health and Family Planning Commission of China.
Tianbing Wang, Xiaofeng Yin, Peixun Zhang, Yuhui Kou, *Baoguo Jiang [email protected] Peking University People’s Hospital and Peking University Traffic Medical Center, 100044 Beijing, China
1
2
3
4
5
6
7
Ministry of Transport of the People’s Republic of China. China transport statistic bullet (in Chinese). 2013. http://www.moc.gov.cn/zfxxgk/ bnssj/zhghs/201405/t20140513_1618277.html (accessed March 25, 2015). Ministry of Public Security of the People’s Republic of China. The sharp increase of vehicles and drivers in China (in Chinese). 2014. http://www.mps.gov.cn/n16/n1252/n1837/ n2557/4330449.html (accessed March 25, 2015). Wang SY, Li YH, Chi GB, et al. Injury-related fatalities in China: an under-recognised publichealth problem. Lancet 2008; 372: 1765–73. National Bureau of Statistics of China. China Statistical Yearbook. China Statistics Press, 2013. http://www.stats.gov.cn/tjsj/ndsj/2013/ indexch.htm (accessed March 25, 2015). WHO. The statistical annexes of the Global status report on road safety 2013. http://www. who.int/violence_injury_prevention/road_ safety_status/2013 (accessed March 25, 2015). Gui L, Gu S, Lu F, Zhou B, Zhang L. Pre-hospital emergency care in Shanghai: present and future. J Emerg Med 2012; 6: 1132–37. Yin XF, Wang TB, Jiang BG, et al. Evaluation of rescue severe trauma injury patients in China by standard procedure. Chin Med J (in press).
Department of Error Lobo MD, Sobotka PA, Stanton A, et al. Central arteriovenous anastomosis for the treatment of patients with uncontrolled hypertension (the ROX CONTROL HTN study): a randomised controlled trial. Lancet 2015; 385: 1634–41— On the fourth page of this Article, the sentence starting on line 5 should read “17 patients (n=10 in the arteriovenous coupler group and n=7 in the control group) had previously undergone renal denervation beyond 6 months of enrolment”, and in the panel Research in context, reference 17 should have been reference 19. These corrections have been made to the online version as of April 24, 2015, and the printed Article is correct. Hersch J, Barratt A, Jansen J, et al. Use of a decision aid including information on overdetection to support informed choice about breast cancer screening: a randomised controlled trial. Lancet 2015; 385: 1642–52—In this Article, the references 19–26 have been corrected. This correction has been made to the online version as of March 26, 2015 and the printed Article is correct. García-Moreno C, Zimmerman C, Morris-Gehring A, et al. Addressing violence against women: a call to action. Lancet 2015; 385: 1685–95—In table 2 of this Series paper, the text in the Indicator column of the Change norms row has been corrected to “More than 50% of women, men, or both believe that some form of violence against women or girls is unacceptable”. This correction has been made to the online version as of Feb 6, 2015, and the printed report is correct.
www.thelancet.com Vol 385 April 25, 2015
