Infectious diseases in children and adolescents in China: analysis of national surveillance data from 2008 to 2017BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1043 (Published 02 April 2020) Cite this as: BMJ 2020;369:m1043
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Dear Editor: Hot Greetings from Neiva City in Colombia S. A. A thousands thanks for your permanent and very polite help in necessary and timely grammar writing correction.
Again, and in this very stressful confinement period, generated by the CoViD19 global impact, we are very pleased to read the excellent scientific article produced by several Chinese Doctors, and published on April 2th, in the last issue BMJ 2020; 369: m1043.
It is impossible to understand those published great results without looking the historical course of China in those years, from 2008 to 2017, which mark and reflect a real historic event, the great and successful social transformation of that country as result of huge economic changes with operative programs for reducing social inequalities among people, and implementing a strong anti corruption control. Great things like these have allowed China to enter in the world most competitive nations. New constitutional and significant economic reforms started on last century 1980s have transformed China itself. They were highly successful reforms because they tackled poverty with excellent results. Implemented reforms in agriculture, in urban industry, in private and foreign businesses, in banking system, have led to radical positive social changes, in science, technology, in wellbeing and people behavior, which have brought Chinese people to a new social status, with a new way of living that severely impact the obsolete dynamics of their curative health sector. Changes introduced have produced very positive outcomes in that sector; one of those are the great victory of people in a new hard battle against traditional and well known pathogens – virus, bacteria, fungi, ciliates, amoebas, nematodes, platyhelminthes, other worms, fleas, lice, mites, mosquitoes, etc.
As we can see in the results section of Yanhui Dong and other Doctors, well done paper, during that decade people were surrounded, all the time, but several kind of microorganisms and other pathogens and hospital and other health dispensaries were not desperately overcrowded by severe affected patients. Sicks have presented the clinical characteristics of people susceptible to many infectious diseases, with severe lowered or depressed immune system, with signs and symptoms of mumps, seasonal influenza, tuberculosis, smallpox, measles, yellow fever, and other classical infectious diseases well known for us in all medical schools around the world and because of bad political and economic situations, in several poor and depressed countries they occupy privileged sites among the morbidity and mortality indexes. In those places, diseases produced by external pathogens are a priority for their health system, and government members and social leaders living in similar conditions like those lived by Chinese people before the last century 1980s, cannot solve yet the problem.
Times have severely changed. Nowadays we are living an era similar to that lived during the last part of 18th century in times of the so called Industrial Revolution, which brought about great and radical changes in social dynamics. But there is a big difference, nowadays machines, computers, mobile phones and robots are most powerful than those invented and created in that time. If you remember history the advent of Watt machines had produced a very critical social situation. In order to solve that problem the London government had created a tax, which should had been paid by the machines owners. With the monthly collected money they had created a very solid, until now, social security system, which had spread to several European countries, and it still exists. Social reforms made by that government in those times, had helped people with housing, welfare, education and sanitation. During that period had flourished the medical practice. That was the time of the bacteriological era, in which rapid development began to take place in science and technology. Several hospitals and dispensaries began to work as centers for health restoration. The best standards for people living were promoted. People had had the sufficient money for housing and well eating. Of course as China did, health problems during the industrial revolution were temporarily solved.
In conclusion there is no other rational option. The solution is not creating new medical or nursing schools, nor bringing undergraduate students from health schools to poor and depressed communities. The only real solution consists in creating a very solid social protection system without corruption, with better daily salary wages or rational stipends for families that guarantee a healthy people's living. It's urgent and necessary to reduce social inequalities, to promote primary and quaternary prevention, and to ameliorate the health information system for making an effective health surveillance.
Competing interests: No competing interests
China's success in infectious disease control in the pre-covid 19 era is impressive. But it is a pity that the incidence of infectious diarrhoea could not be reduced in the observed period. Hand washing with soap and water is well documented as an important hygiene behaviour to prevent diarrhoea (1). The best known hand washing guidelines are those from the World Health Organization WHO (2).
The areas of the hand most neglected during hand washing are the fingertips (3,4) and the thumb (4). The reason for this unfavourable hand washing behaviour probably lies in the anatomy of the hand and the hand/brain interaction. In order to wash the fingertips properly , you have to rub them against another hand part. The claw hand position, which is necessary for such an action, do not seem to be formed naturally when washing our hands. The reason for neglecting the thumb when hand washing could be its anatomy and history of evolution. Wherby the thumb lies away from the other four fingers. Therefore, you have to put your thumb into the palm of the opposite hand in order to washi it. During the evolution to homo sapiens the thumb has developed the most compared with fingers II-V. It has grown longer (5). Therefore, and because of its saddle joint the thumb can reach every other finger of the hand, which was not yet possible with our early ancestors (5). This development led to a wide range of uses for the thumb. That it is why it occupies a large area in the brain (6).
To develop a good hand washing technique, children have to be instructed specifically to form the claw hand position and to put the thumb in the opposite palm in order to wash their fingertips and thumbs sufficiently. At the beginning it is not so easy for children. They have to concentrate on the activity described above. Therefor, they need mental energy (7). But over time and with a lot of training it will get easier and becomes habitual. What becomes habitual in childhood may be preserved into adolescence.
Intensified hand washing instructions may reduce the incidence of infectious diarrhoea in China. It is worth investing heavily in hand hygiene. Children who wash their hands well protect themselves and prevent the spread of infections to others.
In the days of Covid-19, hand washing became very important in prevention of respiratory infection as well.
1. Hand washing promotion for preventing diarrhoea: Cochrane Systematic Reviews, Version published 08 Sept. 2015
2. Clean hands protect against infection, www.who.int
3. Wong J.S.W. et al. The common missed handwashing instances and areas after 15 years of hand-hygiene education, J Environ Public Health 2019; https://doi.org//10.1155/2019/5928924
4. Taylor L.J. An evaluation of hand washing techniques 1+2: Nurs Times, Jan. 12/19, 1978
5. Lundborg G.,The hand and the brain, Springer Verlag London 2014
6. Arslan O.E. Neuroanatomical basis of clinical neurology, CRC Press, 2001
7. Kahneman D. Thinking fast and slow; Farrar, Straus and Giroux, New York 2011
Competing interests: No competing interests