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.
Humans ; China ; Hong Kong ; Macau ; Public Health

OBJECTIVETo 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.

METHODSBased 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.

RESULTSDuring 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.

CONCLUSIONEvidence 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.

Aging ; Cardiovascular Diseases ; mortality ; Humans ; Macau ; epidemiology ; National Health Programs

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.
Antioxidants ; pharmacology ; Ecosystem ; Free Radical Scavengers ; pharmacology ; Macau ; Plant Extracts ; pharmacology

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.、.
Asians ; Humans ; Macau ; Male ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms/diagnosis*

BACKGROUNDAging 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.

METHODSBetween 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.

RESULTSProstate 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).

CONCLUSIONSThere 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.

Aged ; China ; ethnology ; Humans ; Incidence ; Macau ; epidemiology ; Male ; Middle Aged ; Portugal ; ethnology ; Prostatic Neoplasms ; blood ; epidemiology ; pathology

BACKGROUNDThe 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.

METHODSAntimicrobial 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).

RESULTSImipenem 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.

CONCLUSIONSThe 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.

Anti-Infective Agents ; pharmacology ; China ; Drug Resistance, Microbial ; genetics ; Electrophoresis, Gel, Pulsed-Field ; methods ; Escherichia coli ; drug effects ; enzymology ; genetics ; Genotype ; Isoelectric Focusing ; Macau ; beta-Lactamases ; genetics ; metabolism

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.
Adolescent ; Adult ; Body Mass Index ; China/epidemiology* ; Cost of Illness ; Diabetes Mellitus/ethnology* ; Disabled Persons ; Humans ; Macau ; Male ; Middle Aged ; Quality-Adjusted Life Years ; Sickness Impact Profile ; Young Adult

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.
Abortion, Spontaneous ; Asian Continental Ancestry Group ; Child ; China ; Delivery of Health Care ; Female ; Health Occupations ; Health Surveys ; Humans ; Infant, Newborn ; Macau ; Mothers ; Parturition ; Pregnancy ; Pregnant Women ; Prevalence ; Quality of Life ; Stillbirth ; Stress, Psychological

BACKGROUNDSince 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.

METHODSA 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.

RESULTSIt 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%).

CONCLUSIONSMortality 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.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cause of Death ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Infant, Newborn ; Macau ; epidemiology ; Male ; Middle Aged ; Neoplasms ; mortality ; Primary Health Care ; Retrospective Studies ; Time Factors

BACKGROUNDThe 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.

METHODSFrom 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.

RESULTSThe 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.

CONCLUSIONSThe 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.

Adolescent ; Adult ; Aged ; Antiviral Agents ; therapeutic use ; Child ; Child, Preschool ; China ; Female ; Humans ; Influenza A Virus, H1N1 Subtype ; drug effects ; genetics ; pathogenicity ; Influenza, Human ; diagnosis ; drug therapy ; pathology ; Macau ; Male ; Middle Aged ; Oseltamivir ; therapeutic use ; Reverse Transcriptase Polymerase Chain Reaction ; Young Adult