Emergency department in hospitals, a window of the world : a preliminary comparison between Australia and China

BACKGROUND: This study aimed to make a preliminary comparison of emergency department (ED) presentations between Australia and China. The comparison could provide insights into the health systems and burden of diseases and potentially stimulate discussion about the development of acute health system in China. METHODS: An observational study was performed to compare Australian ED presentations using data obtained from a single adult tertiary-referral teaching hospital in metropolitan Brisbane against Chinese ED presentations using public domain information published in existing Chinese and international medical journals. RESULTS: There are major differences in ED presentations between Australia and China. In 2008, 1) 35.4% of patients arrived at a tertiary teaching hospital ED in Brisbane, Australia by ambulance; 2) 1.7% were treated for poisoning; 3) 1.4% for cerebral vascular disease; 4) 1.7% for cardiac disease; and 5) 42.6% for trauma. The top events diagnosed were mental health problems including general psychiatric examination, psychiatric review, alcohol abuse, and counselling for alcohol abuse, which accounted for 5.5% of all ED presentations. Among ED patients in China, 6.7% arrived at a tertiary teaching hospital by ambulance in Shenyang in 1997; 3.7% were treated for poisoning in Shanxi Zhouzhi County People's Hospital ED in 2006; 14.9% for cerebral vascular diseases at Qinghai People's Hospital ED in 1993-1995; 1.7% for cardiac diseases at the Second People's Hospital ED, Shenzhen Longgang in 1993; and 44.3% for trauma at Shanxi Zhouzhi County People's Hospital ED in 2006. The top events were trauma and poisoning among the young and cerebral infarction in the older population. CONCLUSIONS: Compared with Australian, Chinese ED patients had 1) lower ambulance usage; 2) higher proportion of poisoning; 3) higher proportion of cerebral vascular diseases; 4) similar proportion of cardiac disease; 5) similar proportion of trauma; and 6) little reported mental health problems. Possible explanations for these differences in China include a pay for service pre-hospital care system, lack of public awareness about poisons, inadequate hypertension management, and lack of recognition of mental health problems.

The current workforce status of prehospital care in China

Abstract The Chinese Emergency Medicine System is primarily composed of three sectors; prehospital care, emergency department in a city hospital, and intensive care unit ward. While all sectors are integral to the system, the prehospital care system is less developed than the others. There are many possible contributors to the under-development of the prehospital care system, however, workforce issues may play a significant role. Firstly, there is no officially recognised paramedic profession in China. The staff members working in the prehospital care system are medical doctors, registered nurses, patient-carriers, and drivers. Secondly, these doctors and nurses are either over-qualified or under-qualified for practicing in the prehospital care system. Lastly, Chinese health professionals have taken actions to improve the current workforce status with initiatives such as short-term training workshops for doctors and nurses, implementation of a trial unit in a university, and development of a Major Degree of Emergency Medicine in a medical university. All of these actions are important steps toward improving the current workforce status in the prehospital care system. However, a long term workforce development plan is still essential for the Chinese system, and implementation of a professional paramedic education system in a medical university/college in China, may provide the solution. Keywords: China; emergency medicine system; health services; prehospital care system; workforce; service delivery

Suicide rates in Shandong, China, 1991–2010 : rapid decrease in rural rates and steady increase in male–female ratio

Background China has one of the highest suicide rates in the world; however, the recent trends in suicide have not been adequately studied. This study aimed to examine the potential changes in the rates and characteristics in a Chinese population. Methods Data on suicide deaths in 1991–2010 were extracted from the Shandong Disease Surveillance Point (DSP) mortality dataset based on ICD-10 codes. The temporal trend in age-adjusted suicide rates for each subpopulation was tested using log-linear Poisson regression analysis. Results From 1991 to 2010, there was a marked decrease in the overall suicide rate in Shandong, with an average reduction of 8% per year. The decrease trend was stronger in rural than in urban areas and more evident in females than in males. Similar decreases were observed for all age groups. Pesticide ingestion and hanging remained the top two methods for suicide. Limitations There are likely quality concerns in the morality data, such as underreporting and misclassification, as well as low accuracy in determining the underlying causes of deaths. The representativeness of the DSP system may also be problematic due to the rapid changes in economy and demography. Conclusions Completed suicides in Shandong have sharply declined over the past 20 years. Higher rates in females versus males and in rural versus urban areas, which were previously considered to be distinguishing features of suicide in China, are becoming less pronounced.

Scenes, quarters and clusters: The formation and governance of creative places in urban China

This paper presents a PhD program examining the formation and governance patterns of the social and spatial concentration of creative people and creative businesses in cities. It develops a typology for creative places, adding the terms ‘scene’ and ‘quarter’ to ‘clusters’, to fill in the literature gap of partial emphasis on the ‘creative clusters’ model as an organising mechanism for regional and urban policy. The framework is then applied to China, specifically to Hangzhou, a second-tier city in central eastern China that is ambitious to become a ‘national cultural and creative industries centre’. Drawing on in-depth interviews with initiators, managers and creative professionals from three cases selected respectively for scene, quarter and cluster, together with extensive documentary analysis, the paper investigates the composition of actors, characteristics of the locality and the diversity of activities of the three places. The findings demonstrate a convergence of the three terms. Furthermore, in China, planning and government intervention is the key to the governance of creative places; spontaneous development processes exist, but these need a more tolerant environment, a greater diversity of cultural forms and more time to develop. Moreover, the main business development model is still real estate based: this model needs to incorporate more mature business models and an enhanced IP protection system. Finally, the business strategies need to be combined with a self-management model for the creative class, and a collaborative governance mechanism with other stakeholders such as government, real estate developers and education providers.

The extent of the insured’s duty of disclosure : a comparative analysis of the disclosure obligations of insured in Australia, Singapore and China

Pre-contractual material disclosure and representation from an insurance policy proposer is the most important element for insurers to make a decision on whether a proposer is insurable and what are the terms and conditions if the proposal by the proposer is able to be insured. The issue this thesis researches and investigates focus on the issues related to the pre-contractual non-disclosures and misrepresentations of an insured under the principle of utmost good faith, by operation of laws, can achieve with different results in different jurisdiction. A similar disputed claim involving material non-disclosed personal information or misrepresentation at the pre-contractual stage from an insured with respect to both general and life insurance policies settled by an insurer in Australia could be that the policy is set aside ab initio by the insurers in Singapore or China. The jurisdictions this thesis examines are • Australia; • Singapore; and • China including Hong Kong.

Factors affecting the motivation of TEFL academics in higher education in China

This study investigates the motivation of English language lecturers in a Chinese university. Recent studies have shown that low morale and job dissatisfaction are significant problems identified in lecturers who teach English in universities in China. Given the importance of teaching English as a second language in China, this problem has potentially significant ramifications for the nation’s future. Low staff morale is likely to be associated with less effective teaching and poor student learning outcomes. Although the problem is acknowledged, there has been limited research to understand the underlying contributing factors. To address this, a sequential explanatory mixed methods approach was adopted and implemented in two phases at a large regional university in Northern China. The participants in the main study were 100 lecturers from two colleges at this university. All of the lecturers were responsible for teaching English as a foreign language (TEFL); 50 were teaching English majors and 50 were teaching university students whose majors were not English. The research was informed by a synthesis of self determination theory and theories of organisational culture. The study found: 1) in contrast to previously reported studies, lecturers in this institution were in general autonomously motivated in teaching. 2) However, their level of motivation was influenced by their personal experiences and varied sense of competence, relatedness and autonomy. 3) In particular, personal experiences and contextual factors such as the influence of Chinese culture, societal context, and organisational climate were significant in regulating lecturers’ motivation to teach. The findings are significant for leaders in higher education who need to implement policies that foster effective work environments. The study has also provided insights into the capacity of self determination theory to explain motivation in a Chinese culture.

A case-control study of ambient heat exposure and urolithiasis among outdoor workers in a shipbuilding company, Guangzhou, China

Higher ambient temperatures will increase heat stress on workers, leading to impacts upon their individual health and productivity. In particular, research has indicated that higher ambient temperatures can increase the prevalence of urolithiasis. This thesis examines the relationship between ambient heat exposure and urolithiasis among outdoor workers in a shipbuilding company in Guangzhou, China, and makes recommendations for minimising the possible impacts of high ambient temperatures on urolithiasis. A retrospective 1:4 matched case-control study was performed to investigate the association between ambient heat exposure and urolithiasis. Ambient heat exposure was characterised by total exposure time, type of work, department and length of service. The data were obtained from the affiliated hospital of the shipbuilding company under study for the period 2003 to 2010. A conditional logistic regression model was used to estimate the association between heat exposure and urolithiasis. This study found that the odds ratio (OR) of urolithiasis for total exposure time was 1.5 (95% confidence interval (CI): 1.2–1.8). Eight types of work in the shipbuilding company were investigated, including welder, assembler, production security and quality inspector, planing machine operator, spray painter, gas-cutting worker and indoor employee. Five out of eight types of work had significantly higher risks for urolithiasis, and four of the five mainly consisted of outdoors work with ORs of 4.4 (95% CI: 1.7–11.4) for spray painter, 3.8 (95% CI: 1.9–7.2) for welder, 2.7 (95% CI: 1.4–5.0) for production security and quality inspector, and 2.2 (95% CI: 1.1–4.3) for assembler, compared to the reference group (indoor employee). Workers with abnormal blood pressure (hypertension) were more likely to have urolithiasis with an OR of 1.6 (95% CI: 1.0–2.5) compared to those without hypertension. This study contributes to the understanding of the association between ambient heat exposure and urolithiasis among outdoor workers in China. In the context of global climate change, this is particularly important because rising temperatures are expected to increase the prevalence of urolithiasis among outdoor workers, putting greater pressure on productivity, occupational health management and health care systems. The results of this study have clear implications for public health policy and planning, as they indicate that more attention is required to protect outdoor workers from heat-related urolithiasis.

One-year delayed effect of fog on malaria transmission : a time-series analysis in the rain forest area of Mengla County, south-west China

Background: Malaria is a major public health burden in the tropics with the potential to significantly increase in response to climate change. Analyses of data from the recent past can elucidate how short-term variations in weather factors affect malaria transmission. This study explored the impact of climate variability on the transmission of malaria in the tropical rain forest area of Mengla County, south-west China. Methods: Ecological time-series analysis was performed on data collected between 1971 and 1999. Auto-regressive integrated moving average (ARIMA) models were used to evaluate the relationship between weather factors and malaria incidence. Results: At the time scale of months, the predictors for malaria incidence included: minimum temperature, maximum temperature, and fog day frequency. The effect of minimum temperature on malaria incidence was greater in the cool months than in the hot months. The fog day frequency in October had a positive effect on malaria incidence in May of the following year. At the time scale of years, the annual fog day frequency was the only weather predictor of the annual incidence of malaria. Conclusion: Fog day frequency was for the first time found to be a predictor of malaria incidence in a rain forest area. The one-year delayed effect of fog on malaria transmission may involve providing water input and maintaining aquatic breeding sites for mosquitoes in vulnerable times when there is little rainfall in the 6-month dry seasons. These findings should be considered in the prediction of future patterns of malaria for similar tropical rain forest areas worldwide.

Spatial and temporal distribution of falciparum malaria in China

Background: Falciparum malaria is the most deadly among the four main types of human malaria. Although great success has been achieved since the launch of the National Malaria Control Programme in 1955, malaria remains a serious public health problem in China. This paper aimed to analyse the geographic distribution, demographic patterns and time trends of falciparum malaria in China. Methods: The annual numbers of falciparum malaria cases during 1992–2003 and the individual case reports of each clinical falciparum malaria during 2004–2005 were extracted from communicable disease information systems in China Center for Diseases Control and Prevention. The annual number of cases and the annual incidence were mapped by matching them to corresponding province- and county-level administrative units in a geographic information system. The distribution of falciparum malaria by age, gender and origin of infection was analysed. Time-series analysis was conducted to investigate the relationship between the falciparum malaria in the endemic provinces and the imported falciparum malaria in non-endemic provinces. Results: Falciparum malaria was endemic in two provinces of China during 2004–05. Imported malaria was reported in 26 non-endemic provinces. Annual incidence of falciparum malaria was mapped at county level in the two endemic provinces of China: Yunnan and Hainan. The sex ratio (male vs. female) for the number of cases in Yunnan was 1.6 in the children of 0–15 years and it reached 5.7 in the adults over 15 years of age. The number of malaria cases in Yunnan was positively correlated with the imported malaria of concurrent months in the non-endemic provinces. Conclusion: The endemic area of falciparum malaria in China has remained restricted to two provinces, Yunnan and Hainan. Stable transmission occurs in the bordering region of Yunnan and the hilly-forested south of Hainan. The age and gender distribution in the endemic area is characterized by the predominance of adult men cases. Imported falciparum malaria in the non-endemic area of China, affected mainly by the malaria transmission in Yunnan, has increased both spatially and temporally. Specific intervention measures targeted at the mobile population groups are warranted.

Traffic harmony in China? Investigating driver perceptions of traffic law enforcement and social responsibility for harmonious road use.

Social harmony can manifest in many ways. In rapidly motorizing countries like China, a growing area of potential disharmony is road use. The increased ability to purchase a car for the first time and a subsequent increase in new drivers has seen several Chinese cities take unprecedented measures to manage congestion. There is a corresponding need to ensure effective traffic law enforcement in promoting a safe environment for all road users. This paper reports qualitative research conducted with Beijing car drivers to investigate perceptions of unsafe road use, penalties for traffic violations, and improvements for the current system. Overall, the findings suggest awareness among drivers of many of the key risk factors. A perceived lack of clarity in how penalties are determined was identified and drivers in-dicated a desire to know how revenue from traffic fines is used. Several suggestions for improving the current system included school/community education about road risks and traffic law. The rise of private car ownership in China may contribute to a more harmonious personal life, but at the same time, may contribute to a decrease in societal harmony. A major challenge for authorities in any country is to promote the idea of a collective responsibility for road safety (traffic harmony), especially to those who perceive that traffic rules do not apply to them. This is a potentially greater challenge for China as it strives to balance harmony on the road and harmony in the broader society.

Realizing 'four comforts' in the urban fringe : the case of White Horse Lake Eco-creative City Project, Hangzhou, China

This article examines a cultural and creative industries park project – the White Horse Lake Ecocreative City on land outside the urban centre of Hangzhou, China, which uses an imaginary rural lifestyle as its key attraction. By analysing government policies and development plans, and through interviews with initiators, managers and creative practitioners, the article first assesses the geographical position, that is, the impact of locality with regard to both hard and soft infrastructure of the project; it then examines the synergies and tensions embedded in the strategic goals, that is, to build the right city for ‘four comforts’ (siyi, 四宜) – for residence, for business, for travel and for culture. The article concludes that Chinese-style cultural conversion remains locked in a top-down ideological framework, one that rural residents and the new ‘creative class’ are expected to respect.

Speed enforcement in China : national, provincial and city initiatives and their success

China is motorizing rapidly, with associated urban road development and extensive construction of motorways. Speeding accounts for about 10% of fatalities, which represents a large decrease from a peak of 17.2% in 2004. Speeding has been addressed at a national level through the introduction of laws and procedural requirements in 2004, in provinces either across all road types or on motorways, and at city level. Typically, documentation of speed enforcement programmes has taken place when new technology (i.e. speed cameras) is introduced, and it is likely that many programmes have not been documented or widely reported. In particular, the national legislation of 2004 and its implementation was associated with a large reduction in fatalities attributed to speeding. In Guangdong Province, after using speed detection equipment, motorway fatalities due to speeding in 2005 decreased by 32.5% comparing with 2004. In Beijing, the number of traffic monitoring units which were used to photograph illegal traffic activities such as traffic light violations, speeding and using bus lanes illegally increased to 1958 by April 1, 2009, and in the future such automated enforcement will become the main means of enforcement, expected to account for 60% of all traffic enforcement in Beijing. This paper provides a brief overview of the speeding enforcement programmes in China which have been documented and their successes.

Peer-led diabetes self-management programme for community-dwelling older people in China : study protocol for a quasi-experimental design

Aim. A protocol for a new peer-led self-management programme for communitydwelling older people with diabetes in Shanghai, China. Background. The increasing prevalence of type 2 diabetes poses major public health challenges. Appropriate education programmes could help people with diabetes to achieve self-management and better health outcomes. Providing education programmes to the fast growing number of people with diabetes present a real challenge to Chinese healthcare system, which is strained for personnel and funding shortages. Empirical literature and expert opinions suggest that peer education programmes are promising. Design. Quasi-experimental. Methods. This study is a non-equivalent control group design (protocol approved in January, 2008). A total of 190 people, with 95 participants in each group, will be recruited from two different, but similar, communities. The programme, based on Social Cognitive Theory, will consist of basic diabetes instruction and social support and self-efficacy enhancing group activities. Basic diabetes instruction sessions will be delivered by health professionals, whereas social support and self-efficacy enhancing group activities will be led by peer leaders. Outcome variables include: self-efficacy, social support, self-management behaviours, depressive status, quality of life and healthcare utilization, which will be measured at baseline, 4 and 12 weeks. Discussion. This theory-based programme tailored to Chinese patients has potential for improving diabetes self-management and subsequent health outcomes. In addition, the delivery mode, through involvement of peer leaders and existing community networks,is especially promising considering healthcare resource shortage in China.

The social mechanism of political deliberation and citizen participation in Guangdong China

Many studies have focused on why deliberative institutions should be established in order to develop Chinese people’s citizenry skills; however few focus on the social conditions and public sentiments that shape the development of deliberative mechanisms. Skills and awareness of citizenry is not only brought into being by deliberative institutions that are set up by the government, but evolve through interplays between technologies and social changes. As a test-bed for economic reform Guangdong is increasingly identified by translocality and hybrid culture. This is framed by identity conflict and unrests, much of which is due to soaring wealth polarisation, high volumes of population movement, cultural collisions and ongoing linguistic contestations. These unrests show the region’s transformation goes beyond the economic front. Profound changes are occurring at what anthropologists and philosophers call the changing social conciseness or moral landscape (Ci, 1994; Yan, 2010). The changing social moralities are a reflection of the awareness of individuals’ rights and responsibilities, and their interdependencies from dominant ideologies. This paper discusses Guangdong’s social and cultural characteristics, and questions how existing social conditions allow the staging of political deliberation by facilitating political engagement and the formation of public opinion. The paper will investigate the tragedy of Xiao Yueyue in Foshan, Guangdong, where ‘right’ and ‘responsibility’, ‘self’ and ‘other’ define the public sentiments of deliberation and participation.

Does weaker copyright mean stronger creative industries? Some lessons from China

We review the theory of intellectual property (IP) in the creative industries (CI) from the evolutionary economic perspective based on evidence from China. We argue that many current confusions and dysfunctions about IP can be traced to three widely overlooked aspects of the growth of knowledge context of IP in the CI: (1) the effect of globalization; (2) the dominating relative economic value of reuse of creative output over monopoly incentives to create input; and (3) the evolution of business models in response to institutional change. We conclude that a substantial weakening of copyright will, in theory, produce positive net public and private gain due to the evolutionary dynamics of all three dimensions.