Current status of public health system in Guangdong-Hong Kong-Macao Greater Bay Area and improvement suggestion / 中华流行病学杂志

Guangdong-Hong Kong-Macao Greater Bay Area (GBA) has three public health systems under different systems, which plays an important role in the construction of the public health system in China. Further strengthening the construction of the public health system in the GBA will play an important reference role in the optimization and upgrade of China's public health system in the future. Based on the key consulting project of "research on the strategy of the modern public health system and capacity building in China" by Chinese Academy of Engineering, this paper deeply analyzes the current status and existing problems of public health system construction in GBA and suggests to improve and innovate the mechanisms of collaborative prevention and control of public health risks, resource coordination and joint research and result sharing, information sharing and exchange, personnel training and team building in order to comprehensively improve the capacity of public health system in GBA, and promote the construction of Healthy China.

Prostate health index for the diagnosis of prostate cancer in Asians in Macau with a PSA level of 4－10 μg/L / 中华男科学杂志

Objective@#To evaluate the prostate health index (PHI) as a tool for the diagnosis of PCa with a PSA level of 4－10 μg/L and determine the best cut-off value of PHI.@*METHODS@#Fifty-eight patients with a PSA level of 4－10 μg/L underwent transrectal ultrasound-guided prostatic biopsy in our hospital between April 2017 and June 2019. We constructed receiver operating characteristic (ROC) curves for the relationship of the biopsy results with the level of PSA, the ratio of ［－2］ proPSA to fPSA and PHI, and calculated the area under the ROC curves (AUC).@*RESULTS@#Prostatic biopsy revealed 18 cases of PCa in the 58 patients (31.0%). Statistically significant differences were observed between the PCa and non-PCa groups in ［－2］ proPSA, %［－2］ proPSA and PHI, but not in tPSA, % fPSA and PSA-density. The AUCs of PSA, % fPSA, PSA-density, ［－2］ proPSA, %［－2］ proPSA and PHI were 0.556, 0.407, 0.533, 0.746, 0.751 and 0.774, respectively. The specificity of PHI was 27.50% (95% CI: 14.6%－43.9%), the highest among the above predictors at 90% sensitivity. By applying PHI to this cohort, 13 cases (22.4%) of unnecessary biopsy could be avoided.@*CONCLUSIONS@#The application of PHI can increase the accuracy of PCa prediction and reduce unnecessary prostatic biopsy.、.

Disease burden of diabetes attributable to high body mass index in China,1990-2016 / 中华流行病学杂志

Objective: To analyze the burden of disease (BOD) on diabetes attributable to high BMI in China from 1990 to 2016. Methods: Data based on population of the 2016 Global Burden of Disease Study for China were used to analyze the attributable fractions (PAF) of BOD for diabetes attributable to high BMI. Measurements for attributable BOD of diabetes included disability adjusted life years (DALY), years of lost life (YLL), years living with disability (YLD), death number and mortality rate. The average world population from 2010 to 2035 was used as a reference. Results: In 2016, death number of diabetes attributable to high BMI was 40 310, which was significantly higher than that in 1990 (15 008). Age-standardized death rate of diabetes attributable to high BMI increased from 2.01/100 000 in 1990 to 2.60/100 000 in 2016, which showed a more significant increasing trend in both males and people aged 15-49 years. DALYs of diabetes attributable to high BMI increased from 1.09 million person years to 3.30 million person years. YLL and YLD also showed increasing trends. The highest increasing rate of YLD was in people aged 15-49 years. High BMI was responsible for 26.01% of the diabetes deaths in 2016 in China, an increase of 39.39% compared with that in 1990 (18.66%). Most provinces in China experienced a sharp increase of DALY of diabetes attributable to high BMI from 1990 to 2016. Inner Mongolia, Xinjiang, Zhejiang, Macao SAR, Sichuan and Qinghai had the most significant increase tendency in terms of DALY rate during this period. Conclusions: There was a rapid increase of the deaths and mortality rate of diabetes attributable to high BMI, causing a heavy disease burden, in China from 1990 to 2016. The BOD varied in both different age and gender groups. More attention should be paid to males and people aged 15-49 years in the prevention and control programs of diabetes.

Uses of fresh herbs with antioxidant effect and prospect for population ecology reconstruction in Macau / 中国中药杂志

The average life expectancy in Macau is ranking the second in the world, the consumption of fresh medicinal plants is a profound culture in Macau. The paper focus on the distribution of the antioxidant herbs, a comprehensive investigation and analysis the amount of the plant resources was carried out. The antioxidant activity of alcohol extracts was determined by using the DPPH method, and six kinds fresh herbs with high antioxidant free radical activity were screened out. Reference to adult daily dose of vitamin C, it is calculated that the daily dose amount of fresh herbs is less than 200 g. For the expected shortage of resources and the ecological status of Macau, we give some suggestions of herbal introduction in population ecology reconstruction.

Impact of Macao Medical Voucher Program on health outcomes of the residents: changes of mortality from circulatory system diseases / 南方医科大学学报

<p><b>OBJECTIVE</b>To examine whether the implementation of Macao Medical Voucher Program has helped promote the health outcomes of the residents in the case of mortality from circulatory system diseases.</p><p><b>METHODS</b>Based on 144 monthly observations of the mortality from circulatory system diseases in Macao during 2001-2012, we carried out a trend analysis of the time series to identify significant differences in the mortality data after the implementation of the Medical Voucher in Macao. This study was controlled for the compounding factors including medical resources (numbers of physicians, nurses and patient beds per thousand population and public healthcare expenditure), economic development level (GDP per capita), social human development level, population aging factor, natural seasonal effects and long-term trends.</p><p><b>RESULTS</b>During 2010-2012 when the Medical Voucher Program in Macao was implemented, the annual mortality rates from circulatory system diseases were significantly lowered by 24% as compared with those recorded during 2001-2009 (P<0.01), which was equivalent to avoiding 123 deaths related of circulatory system diseases per year.</p><p><b>CONCLUSION</b>Evidence in this study suggests a robust connection between the timing of the implementation of Macao Medical Voucher Program and a significant decrease in the mortality from circulatory system diseases in Macao, but their causal relationship awaits confirmation in further research.</p>

Changes in main causes of death in Macao residents from 1986 - 2006 / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Since Macao's return of sovereignty to China in December 1999, the life style of Macao residents has changed. The aim of this study was to investigate changes of death patterns in Macao residents from 1986 to 2006 in order to identify the trends and patterns of major public health problems, which could provide the guidance for developing public health policies.</p><p><b>METHODS</b>A retrospective study was conducted for this investigation. Research data were collected from official websites and statistical yearbooks and classified by the International Classification of Diseases (ICD)-9.</p><p><b>RESULTS</b>It was observed that mortality from the three major causes of (1) infectious, maternal and childhood diseases, (2) chronic non-communicable diseases, and (3) injury and poisoning were 17.7, 298.2 and 26.0 per 100 000, respectively. The largest decrease in death rate over the 21-year study-period was from infectious, maternal and childhood diseases (62.5%). The highest mortality rate was ischemic heart diseases (37.0%). The largest increase in mortality rate was lung cancer (46.9%).</p><p><b>CONCLUSIONS</b>Mortality rate of Macao residents progressively decreased, but the constituent ratio of death from chronic non-communicable diseases was increasing. The mortality rate of lung cancer was clearly ascending, so emphasis should be put on tertiary prevention in future.</p>

Traditional Chinese Pregnancy Restrictions, Health-Related Quality of Life and Perceived Stress among Pregnant Women in Macao, China

PURPOSE: The objectives of this study were to identify the prevalence and rationales of traditional Chinese pregnancy restrictions and to investigate the relationship between pregnancy restriction, health-related quality of life, and perceived stress level at a two-stage design. METHODS: Stage I consisted of exploring the traditional Chinese pregnancy restrictions and their underlying beliefs based on extensive literature review followed by in-depth interviews with 30 pregnant women. Stage II investigated the relationship between pregnancy restrictions, health-related quality of life, and perceived stress among 1,151 women. Self-developed traditional Chinese pregnancy restrictions lists were measured on adherence towards the traditional Chinese pregnancy restriction. Perceived stress and health-related quality of life were measured by the Perceived Stress Scale and the Short Form-12 (SF-12) Health Survey, respectively. RESULTS: The majority of the women adhered to traditional Chinese pregnancy restrictions in order to protect the unborn child from danger and to avoid the problems associated pregnancy and birth, such as miscarriage, stillbirth, death of the mother, and imperfections in the newborn. Pregnant women who adhered to behavioral restrictions were more likely to associate with poor physical component of healthrelated quality of life. However, there was no significant difference between pregnancy restrictions and Perceived Stress Scale scores. CONCLUSION: The findings provided cultural rationales of pregnancy restrictions within a Macao context that may assist health professionals to better understand women from different cultures. It is essential in the development of culturally appropriate healthcare to support women in making a healthy transition to motherhood.

Antimicrobial resistance, genotypic characterization and pulsed-field gel electrophoresis typing of extended spectrum β-lactamases-producing clinical Escherichia coli strains in Macao, China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The rise of the production of CTX-M class extended spectrum β-lactamases (ESBLs) has been well documented in traveling countries but no data are found for Macao, an international travel city. The objectives of this study were to identify the antimicrobial resistance pattern, and determine the prevalence, genotype and clonal relationship of ESBLs in 209 clinical Escherichia coli strains from Macao, China.</p><p><b>METHODS</b>Antimicrobial susceptibility test was performed to determine the resistance patterns of the isolates using the disk diffusion method with 17 antimicrobial agents. Phenotypic detection was screened and confirmed according to the Clinical and Laboratory Standards Institute. Genotypic characterization was detected by isoelectric focusing analysis, polymerase chain reaction and sequencing. The clonal relationship between the different ESBL isolates was studied by pulsed-field gel electrophoresis (PFGE).</p><p><b>RESULTS</b>Imipenem and meropenem exhibited 100% susceptible among 209 strains. Overall, 82.3%, 67.3%, 52.9%, 51.2% and 51.0% of the isolates displayed resistance to ampicillin, tetracycline, ciprofloxacin, sulfamethoxazole trimethoprim and gentamycin. The prevalence rate of ESBLs was 30.1%. Antibiotic resistances were found to be significantly higher among the ESBL producing group compared to non-ESBL producing group. We detected CTX-M-14 to be the major genotypic characterization of ESBLs (76.2%). Two strains showed indistinguishable patterns by PFGE.</p><p><b>CONCLUSIONS</b>The prevalence of antimicrobial resistance is alarming high in Macao. Antimicrobial resistance is significantly higher among the ESBL producing group. This study documented CTX-M-14 as the predominant ESBL type. Although indistinguishable pattern was found between two strains, it was too small to decide whether any of the investigated strains was epidemic. Our findings may be also pertinent for other geographic areas undergoing similar travel characteristics to understand the corresponding effects on bacterial populations.</p>

Clinical features of initial cases of 2009 pandemic influenza A (H1N1) in Macau, China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The first case of pandemic influenza A (H1N1) virus infection in Macau Special Administrative Region (SAR) of the People's Republic of China was documented on June 18, 2009. Subsequently, persons with suspected infection or of contact with suspected cases received screening. All the confirmed cases were hospitalized and treated with oseltamivir. Their clinical features were observed. This may help for better management for later patients and be of benefit to the government of Macau SAR to adjust its strategy to combat the pandemic influenza A (H1N1) virus infection more efficiently.</p><p><b>METHODS</b>From June to July 2009, the initial 72 cases of influenza A (H1N1) in Macau were hospitalized in Common Hospital Centre S. Januario (CHCSJ). The infection was confirmed by real-time reverse-transcriptase polymerase chain reaction (RT-PCR). The clinical features of the disease were closely observed and documented. Oseltamivir was given to all patients within 48 hours after the onset of disease and maintained for 5 days.</p><p><b>RESULTS</b>The mean age of the 72 patients was 21 years old. Forty of them were men and 32 were women. The median incubation of the virus was 2 days (1 to 7 days). The most common symptoms were fever (97.2%) and cough (77.8%). The rate of gastrointestinal symptoms including nausea, vomiting, and diarrhea was 2.8%. Fever typically lasted for 3 days (1 to 9 days). The median time from the onset to positive results of real-time RT-PCR was 6 days (3 to 13 days). After treatment with oseltamivir, most patients became afebrile within 48 hours. Only one aged patient with a history of glaucoma and hypothyroidism was found to have lung infiltration on chest X-ray.</p><p><b>CONCLUSIONS</b>The initial cases of pandemic influenza A (H1N1) virus infection in Macau SAR showed that most of the infected persons had a mild course. The virus could be detected by real-time RT-PCR within a median of 6 days from the onset. Oseltamivir was effective.</p>

Comparisons of the incidence and pathological characteristics of prostate cancer between Chinese and Portuguese in Macau / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Aging of population in Macau has become a serious problem and we are diagnosing more and more patients with prostate cancer. To investigate the effect of ethnicity and environment on incidence of prostate carcinoma, we compared the difference of biopsy and postoperative pathology of prostate between indigenous Chinese (Chinese) and Chinese of Portuguese descent (Portuguese) with elevated serologic prostate specific antigen (PSA) and incidence of prostate carcinoma in Macau.</p><p><b>METHODS</b>Between 1999 and 2006, prostate biopsy was performed in a random sample of 462 patients with elevated serologic PSA who, on followup, were diagnosed in this hospital with benign prostate hyperplasia. Of these, 416 were indigenous Chinese, 46 Portuguese. Based on demographic statistics by Macau government for 2005, we compared differences in incidences of prostate carcinoma, positive rate of random prostate biopsy in patients with elevated serologic PSA, factors related to serological PSA and pathological grade and stage between both ethnic groups.</p><p><b>RESULTS</b>Prostate carcinoma was diagnosed on biopsy in 178 cases. Positive biopsies of prostate carcinoma were present in 160 Chinese with positive rate of 38.5% and in 18 Portuguese with 39.1%. For patients diagnosed with prostate carcinoma, there was no significant difference in age, incidence, grade of cancerous cells, stage of the disease, incidence of inflammation of prostatic tissues or prostatic intraepithelial neoplasia (PIN) related to elevated PSA between the groups (All P>0.05).</p><p><b>CONCLUSIONS</b>There was no significant difference in incidence or characteristics of prostate carcinoma between people of Portuguese and Chinese descent in Macau based on our limited data. Long term residence in the same environment may be associated with the incidence and progression of prostate carcinoma in Portuguese living in Macau, but further rigorous epidemiological investigation and analysis of risk factors about prostate carcinoma are needed to corroborate this conclusion.</p>

Neonatal screening in Hong Kong and Macau.

For the implementation of the neonatal screening program, the following factors have to be considered for the selection of conditions to be screened and evaluation of outcome. These include the factors pertaining to public health impact, availability and acceptability of the screening system, and other social issues involved in the implementation. In the context of Hong Kong, Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency and Congenital Hypothyroidism (CHT) have been highlighted in the early 1980s for consideration. A territory wide program for screening these conditions was started in 1984. Since then, over 99% of all newborns in Hong Kong was screened. Of these, around 70% were delivered in public hospitals, and the remaining were from private hospitals. Pre-screening education was emphasized, and 95% of pregnant ladies received information about this screening program from the Maternity and Child Health Centers run by the Department of Health, Hong Kong. For those who were born in public hospitals, the incidence of CHT was 1 in 2404 (269/646,580), while that of G6PD deficiency was 4.5% in male newborns and 0.3% in female newborns. This paper highlights details of the screening program, including its outcome evaluation. In Macau, CHT screening has not been started. Instead, G6PD deficiency screening commenced in 1977 in one of the two major hospitals where most newborns are delivered. Methodology and results of this program are presented.

Enterobiasis among schoolchildren in Macao.

The prevalence of enterobiasis was investigated among 2,195 children in kindergarten and grade one of 12 Macao Catholic schools by a single modified Scotch tape swab. The overall infection rate was 31.5%; it ranged from 15.2% to 63.3% among schools and was higher in grade one. The prevalence was independent of sex but increased with age to a peak at 7 years; it was higher among children of lower social class and those born in Mainland China. The infection was more prevalent in the poor and congested parts of the city. The educational level of parents was a critical factor in the eradication of enterobiasis. The prevalence rate was not associated with the employment status of mother, family size, and sibling size.