Correspondence
5
6
Walls HL, Wolfe R, Haby MM, et al. Trends in BMI of urban Australian adults, 1980–2000. Public Health Nutr 2010; 13: 631–38. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA 2014; 311: 806–14.
Authors’ reply We welcome the Correspondence from Catherine Keating and colleagues commenting on our recent Article1 and thank them for their suggested steps to improve the quality of global obesity surveillance. We agree that stratification of trends by socioeconomic status is important and relevant to understanding the obesity epidemic. In our study, we have focused mainly on estimating the national trends and revealing the intercountry similarities and differences. Intracountry variation was not studied. To address this limitation, the Global Burden of Disease Study is gradually incorporating sub-national analysis in some countries to generate the most policy-relevant results. One challenge, however, is the scarcity of reliable data for subpopulations. Surveillance and surveys are often designed to be nationally representative. To capture subnational and subpopulation information, a comprehensive monitoring system should be developed to allow gathering of data at a more localised level. Regarding the authors’ second point, we agree that it is important to examine the composition of the obese population according to severity. Again, the scarcity of data is a substantial challenge in the estimation process. Obesity is a pressing health issue worldwide. Effective monitoring and surveillance are crucial to inform action and trace success. I declare no competing interests.
Emmanuela Gakidou [email protected] Institute for Health Metrics and Evaluation, Seattle, WA 98121, USA 1
2108
Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384: 766–81.
Education of health professionals in China
1
Hou J, Michaud C, Li Z, et al. Transformation of the education of health professionals in China: progress and challenges. Lancet 2014; 384: 819–27. Duvivier RJ, Boulet JR, Opalek A, van Zanten M, Norcini J. Overview of the world’s medical schools: an update. Med Educ 2014; 48: 860–69.
With great interest I read Jianlin Hou and colleagues’ Review (Aug 30, p 819).1 I applaud the initiative of China’s Ministry of Education to provide previously unreleased data on the number of health professional graduates and faculty by school. I respectfully request this information to be made publicly available: improved data can drive research on the quality of schools and their graduates, both in China and worldwide. We recently reported an overview of the world’s medical schools,2 and identified many challenges associated with counting schools and tracking information at school level. Nevertheless, to help meet the projected demand for health professionals in China, its government must pay attention, not only to the number and capacity of their training institutions, but also to their quality. Hou and colleagues provide observations on the quality of health professional education, but do not comment on the availability of outcome measures, such as government recognition and oversight, licensure and test scores, or process measures, such as qualifications of faculty staff. The absence of standard setting processes, accreditation, and licensing processes poses a real threat to the quality of the educational institutions of health professionals in China. Rigid and static educational methods are prevalent—incorporation of adult learning principles coupled with state-of-the-art assessment and evaluation are urgently needed to bring the education of China’s health professionals into the 21st century. What China needs are health professionals with the knowledge and skills to bring major educational reform and create meaningful and sustainable advances.
We read with interest the Review by Jianlin Hou and colleagues on the progress and challenges of transformation of the education of health professionals in China.1 We are concerned about the training of nurses. We are worried by the fact that most nurses did not receive standard nursing training. According to figure 1 in the Review,1 in 2012, only 30 000 out of 186 000 graduate nurses earned standard bachelor degrees or above. Most nurses received diplomas associated with brief training. Based on the supplementary materials,1 more than 80% of nurses working in the Chinese medical system received a diploma or lower and lack adequate training. With a 1:1 ratio between doctors and nurses1 and stressful working conditions, inadequately trained nurses could make mistakes during their medical service. The Review 1 on education transformation was accompanied by three pieces of Correspondence2–4 about violence against doctors in China. Although we agree that stronger punishments and other measures should be implemented to reduce violence against health professionals, we also believe that the education of nurses in China could also participate to some degree to the issue of violence against medical personnel.5 Nurses are intermediates between doctors and patients. In our practice, we have seen misunderstanding and mistrust between patients and doctors most probably due to of the inadequate training of nurses. A more comprehensive training system for nurses is needed.
I declare no competing interests.
We declare no competing interests.
Robbert J Duvivier
*Fengxia Liu, Ruili Zhang, Cuizhi Geng, Hong Chen, Yongjun Wang
[email protected] University of Newcastle, Callaghan, NSW 2308, Australia
2
[email protected]
www.thelancet.com Vol 384 December 13, 2014
5
6
Walls HL, Wolfe R, Haby MM, et al. Trends in BMI of urban Australian adults, 1980–2000. Public Health Nutr 2010; 13: 631–38. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA 2014; 311: 806–14.
Authors’ reply We welcome the Correspondence from Catherine Keating and colleagues commenting on our recent Article1 and thank them for their suggested steps to improve the quality of global obesity surveillance. We agree that stratification of trends by socioeconomic status is important and relevant to understanding the obesity epidemic. In our study, we have focused mainly on estimating the national trends and revealing the intercountry similarities and differences. Intracountry variation was not studied. To address this limitation, the Global Burden of Disease Study is gradually incorporating sub-national analysis in some countries to generate the most policy-relevant results. One challenge, however, is the scarcity of reliable data for subpopulations. Surveillance and surveys are often designed to be nationally representative. To capture subnational and subpopulation information, a comprehensive monitoring system should be developed to allow gathering of data at a more localised level. Regarding the authors’ second point, we agree that it is important to examine the composition of the obese population according to severity. Again, the scarcity of data is a substantial challenge in the estimation process. Obesity is a pressing health issue worldwide. Effective monitoring and surveillance are crucial to inform action and trace success. I declare no competing interests.
Emmanuela Gakidou [email protected] Institute for Health Metrics and Evaluation, Seattle, WA 98121, USA 1
2108
Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384: 766–81.
Education of health professionals in China
1
Hou J, Michaud C, Li Z, et al. Transformation of the education of health professionals in China: progress and challenges. Lancet 2014; 384: 819–27. Duvivier RJ, Boulet JR, Opalek A, van Zanten M, Norcini J. Overview of the world’s medical schools: an update. Med Educ 2014; 48: 860–69.
With great interest I read Jianlin Hou and colleagues’ Review (Aug 30, p 819).1 I applaud the initiative of China’s Ministry of Education to provide previously unreleased data on the number of health professional graduates and faculty by school. I respectfully request this information to be made publicly available: improved data can drive research on the quality of schools and their graduates, both in China and worldwide. We recently reported an overview of the world’s medical schools,2 and identified many challenges associated with counting schools and tracking information at school level. Nevertheless, to help meet the projected demand for health professionals in China, its government must pay attention, not only to the number and capacity of their training institutions, but also to their quality. Hou and colleagues provide observations on the quality of health professional education, but do not comment on the availability of outcome measures, such as government recognition and oversight, licensure and test scores, or process measures, such as qualifications of faculty staff. The absence of standard setting processes, accreditation, and licensing processes poses a real threat to the quality of the educational institutions of health professionals in China. Rigid and static educational methods are prevalent—incorporation of adult learning principles coupled with state-of-the-art assessment and evaluation are urgently needed to bring the education of China’s health professionals into the 21st century. What China needs are health professionals with the knowledge and skills to bring major educational reform and create meaningful and sustainable advances.
We read with interest the Review by Jianlin Hou and colleagues on the progress and challenges of transformation of the education of health professionals in China.1 We are concerned about the training of nurses. We are worried by the fact that most nurses did not receive standard nursing training. According to figure 1 in the Review,1 in 2012, only 30 000 out of 186 000 graduate nurses earned standard bachelor degrees or above. Most nurses received diplomas associated with brief training. Based on the supplementary materials,1 more than 80% of nurses working in the Chinese medical system received a diploma or lower and lack adequate training. With a 1:1 ratio between doctors and nurses1 and stressful working conditions, inadequately trained nurses could make mistakes during their medical service. The Review 1 on education transformation was accompanied by three pieces of Correspondence2–4 about violence against doctors in China. Although we agree that stronger punishments and other measures should be implemented to reduce violence against health professionals, we also believe that the education of nurses in China could also participate to some degree to the issue of violence against medical personnel.5 Nurses are intermediates between doctors and patients. In our practice, we have seen misunderstanding and mistrust between patients and doctors most probably due to of the inadequate training of nurses. A more comprehensive training system for nurses is needed.
I declare no competing interests.
We declare no competing interests.
Robbert J Duvivier
*Fengxia Liu, Ruili Zhang, Cuizhi Geng, Hong Chen, Yongjun Wang
[email protected] University of Newcastle, Callaghan, NSW 2308, Australia
2
[email protected]
www.thelancet.com Vol 384 December 13, 2014
