Sian Griffiths

Public-health risks of melamine in milk products

News stories about the contamination of milk with melamine in China fi rst emerged on Sept 11, 2008, and the situation has since become an international health scare. Melamine (also known as tripolycyanamide) is an industrial chemical in the production of melamine resins, which are used in laminates, glues, adhesives, and plastics. When added to milk, melamine increases the nitrogen concentration, which suggests a false increase in protein concentration. Melamine has low oral acute toxicity but excessive exposure in animals causes renal stones. When consumed by human beings, babies and children are aff ected the most because of their dependence for nutrition, compounded by immaturity of their organs, which renders them vulnerable to chemical damage. The practice of mixing preservatives and chemicals, including antibiotics, with milk to make it last longer, taste better, and record higher protein values refl ects an inadequately regulated and managed supply-chain and an agricultural industry in need of reform. Chinese people have only recently started to appreciate milk products and many producers are small farmers, under pressure to maximise milk yield in the face of rising grain prices. Middlemen between milk producers and some of the big dairy companies have been selling substandard milk at discount prices. Although China has a monitoring system for nutritional contents, there is no regular reporting system for the concentration of common chemicals (illegal preservatives), veterinary antibiotic use, and carcinogenic components in dairy products. The Government has now recognised the need for support, training, and investment in the industry to safeguard potential risk to public health. Meanwhile, by Sept 22, the Chinese authorities had reported that 52 857 children had been treated for renal complications. At least four children have died as a direct result. By Sept 28, in Hong Kong where 95% of food is imported, much of it from the mainland, 15 017 children had attended designated clinics. Five of these children were found to have kidney stones, and four of these fi ve had a history of living in the mainland. Because infant formula has been supplied to a large number of countries as far afi eld as Burundi, Yemen, and Tanzania, the UN has issued a worldwide alert and the European Union banned China-made baby-food. In the UK, all products from China containing more than 15% milk as an ingredient will be subject to documentary, identity, and physical checks and those products containing more than 2·5 mg melamine per kg will be destroyed. The USA has advised those travelling to China with small children to take their own baby-food and formula. The Chinese Government’s response has been to curb the risks, punish the perpetrators, and help the victims. The Government has enacted the Emergency Public Health Response Regulations drawn up in 2003 in response to the outbreak of severe acute respiratory syndrome (SARS). This plan formulates a contingency response for major emergencies. However, the plan was drafted for infectious diseases such as SARS, and there are no clear guidelines or regulations which govern responsibilities and liabilities in a case such as that of melamine contamination. The Minister of Health has promised care will be provided free to aff ected children and the Government is providing screening to reassure anxious parents. However, for those with permanent clinical problems and aff ected children beyond China’s borders, fi nancial compensation and long-term follow-up is less certain and questions of liability are as yet unresolved. Public concern was raised after New-Zealand-based food-giant Fonterra learnt from its Chinese partner Sanlu Group that infant formula was contaminated. Re ut er s

Willingness of Hong Kong healthcare workers to accept pre-pandemic influenza vaccination at different WHO alert levels: two questionnaire surveys

Objective To assess the acceptability of pre-pandemic influenza vaccination among healthcare workers in public hospitals in Hong Kong and the effect of escalation in the World Health Organization’s alert level for an influenza pandemic. Design Repeated cross sectional studies using self administered, anonymous questionnaires Setting Surveys at 31 hospital departments of internal medicine, paediatrics, and emergency medicine under the Hong Kong Hospital Authority from January to March 2009 and in May 2009 Participants 2255 healthcare workers completed the questionnaires in the two studies. They were doctors, nurses, or allied health professionals working in the public hospital system. Main outcome measures Stated willingness to accept pre-pandemic influenza vaccination (influenza A subtypes H5N1 or H1N1) and its associating factors. Results The overall willingness to accept pre-pandemic H5N1 vaccine was only 28.4% in the first survey, conducted at WHO influenza pandemic alert phase 3. No significant changes in the level of willingness to accept pre-pandemic H5N1 vaccine were observed despite the escalation to alert phase 5. The willingness to accept pre-pandemic H1N1 vaccine was 47.9% among healthcare workers when the WHO alert level was at phase 5. The most common reasons for an intention to accept were “wish to be protected” and “following health authority’s advice.” The major barriers identified were fear of side effects and doubts about efficacy. More than half of the respondents thought nurses should be the first priority group to receive the vaccines. The strongest positive associating factors were history of seasonal influenza vaccination and perceived risk of contracting the infection. Conclusions The willingness to accept pre-pandemic influenza vaccination was low, and no significant effect was observed with the change in WHO alert level. Further studies are required to elucidate the root cause of the low intention to accept pre-pandemic vaccination.

The impact of parental migration on health status and health behaviours among left behind adolescent school children in China

BackgroundOne out of ten of Chinas population are migrants, moving from rural to urban areas. Many leave their families behind resulting in millions of school children living in their rural home towns without one or both their parents. Little is known about the health status of these left behind children (LBC). This study compares the health status and health-related behaviours of left behind adolescent school children and their counterparts in a rural area in Southern China.MethodsA cross-sectional study was conducted among middle school students in Fuyang Township, Guangdong, China (2007-2008). Information about health behaviours, parental migration and demographic characteristics was collected using a self-administered questionnaire. Overweight/obesity and stunting were defined based on measurements of height and weight. Univariate and multivariate analyses were used to estimate the differences in health outcomes between LBC and non-LBC.Results18.1% of the schoolchildren had one or both parents working away from home. Multivariate analysis showed that male LBC were at higher risk of skipping breakfast, higher levels of physical inactivity, internet addiction, having ever smoked tobacco, suicide ideation, and being overweight. LBC girls were more likely to drink excessive amounts of sweetened beverage, to watch more TV, to have ever smoked or currently smoke tobacco, to have ever drunk alcohol and to binge drinking. They were also more likely to be unhappy, to think of planning suicide and consider leaving home.ConclusionsOur findings suggest that parental migration is a risk factor for unhealthy behaviours amongst adolescent school children in rural China. Further research is required in addition to the consideration of the implications for policies and programmes to protect LBC.

Acceptability of A/H1N1 vaccination during pandemic phase of influenza A/H1N1 in Hong Kong: population based cross sectional survey.

Objective To investigate the intention of the Hong Kong general population to take up vaccination against influenza A/H1N1. Setting Cross sectional population based anonymous survey. Participants Random sample of 301 adults interviewed by telephone (response rate 80%). Main outcome measure Intention to take up vaccination against influenza A/H1N1 under five hypothetical scenarios: vaccination is free; vaccination per dosage costs less than

Cigarette smoking and the risk of colorectal cancer: a meta-analysis of prospective cohort studies.

HK100 (£8; €9;

Obstacles to Colorectal Cancer Screening in Chinese: A Study Based on the Health Belief Model

13),

Widespread public misconception in the early phase of the H1N1 influenza epidemic

HK101-200, or more than

Health care utilisation amongst Shenzhen migrant workers: does being insured make a difference?

HK200; and no data are available on the efficacy and safety of the vaccine. Results 45% (n=135) of the participants reported that they would be highly likely take up vaccination if it was free. When vaccination incurred a cost, however, the prevalence of uptake decreased: 36% (n=108) would take up vaccination if it cost less than

Anticipated and current preventive behaviors in response to an anticipated human-to-human H5N1 epidemic in the Hong Kong Chinese general population

HK100, 24% (n=72) if it cost

A study of intracity variation of temperature-related mortality and socioeconomic status among the Chinese population in Hong Kong

HK101-200, and 15% (n=45) if it cost more than