Fellowship Site: Shanghai, China

The Shanghai Municipal Center for Disease Control and Prevention, modeled on the U.S. Centers for Disease Control and Prevention (CDC), provides central public health organization integrated with responsibility for community and individual health needs. Its major mission is to make evidence-based recommendations for public health policy and planning. The SMCDCP partners with all major regional hospitals and medical universities for clinical research and works with academic associations, experts, and volunteers in all major health fields. On the international level, it collaborates with the World Health Organization, the World Bank, the United Nations International Children's Emergency Fund, the European Union, the U.S. CDC and NIH, the State of California Department of Health Services, Vanderbilt University School of Medicine, and the University of Toronto, Canada.

The SMCDCP is developing its leadership role in the China/southeast Asia region in chronic disease prevention and control. It is currently leading the development of a three-tier medical network for community-based chronic disease intervention in China, which consists of the SMCDCP, district/county CDCs, and community health service centers. The SMCDCP has built the largest Asian cohort of diabetes patients (38,000 patients) targeted for community-based intervention and computer information management.

SMCDCP is also developing leadership in cancer research. Over the past decade, in collaboration with the Vanderbilt Epidemiology Center (VEC) at the Vanderbilt Institute of Medicine and Public Health (IMPH), SMCDCP has conducted several large scale collaborative epidemiological studies investigating the etiology of cancer and other chronic diseases, as well as prognosis and quality of life for cancer survivors. Several researchers from SMCDCP have received training at IMPH.

The VEC hosts more than 30 NIH-funded research projects. List below are selected ongoing projects that are conducted in collaboration with Chinese institutes and in which the PI plays a major role. These projects provide excellent training opportunities for both U.S. and Chinese trainees.

• Shanghai Women's Health Study (R01 CA70867): This is a large population-based prospective cohort study initiated in 1996. From 1996 to 2000, approximately 75,000 Chinese women who lived in Shanghai were recruited into the study (AJE, 162:1123, 2005). In addition to survey data, most study participants donated blood and urine samples at baseline. This cohort of women are being followed for the occurrence of cancer and several common diseases through biennial home visits and record linkage with files routinely collected by the Shanghai Cancer Registry and the Vital Statistics Unit. In the current funding cycle, the study focuses on evaluating dietary factors that may reduce the risk of cancers. The resources from this study have supported multiple projects that address etiologic hypotheses for cancers, and other chronic diseases, such as coronary heart diseases, asthma, diabetes, stroke, hypertension, and bone fracture.
• Shanghai Men's Health Study (R01 CA82729): The Shanghai Men's Health Study (SMHS) is a population-based cohort study of 61,582 men that is being conducted in parallel with the SWHS. In addition to survey data, two-thirds of study participants provided a blood sample, and near 90% provided a urine sample to the study. Two food frequency questionnaires were/are being administered in person two years apart. The cohort is being followed through a combination of biennial home visits of all living subjects and record linkages with data collected by the Shanghai Cancer Registry and Vital Statistics Unit on mortality, occurrence of cancer and major chronic diseases including diabetes, hypertension, cardiovascular disease, and bone fracture.
• Shanghai Breast Cancer Survival Study (DAMD 17-02-1-0607, R01 CA118229): The Shanghai Breast Cancer Survival Study (SBCSS) is a population-based cohort study of 5000 breast cancer survivors. Through the population-based Shanghai Cancer Registry, 5046 (80.1% response rate) women with newly diagnosed breast cancer living in urban Shanghai and between ages of 25 and 74 were identified between April 1, 2002 to December 31, 2006 and recruited to study approximately 6 months after their cancer diagnosis. The study includes multiple in-person interviews, administered at 6, 18, 36 and 60 months after cancer diagnosis, which collect information on cancer diagnosis, treatment, progression, lifestyle factors, and quality of life. Medical charts were abstracted and tumor slides were collected. The vast majority of study participants (96%) have provided DNA samples to the study. The study has been recently expanded to study depression, cognitive decline, bone density, and cardiovascular outcomes among breast cancer survivors.
• Soyfood and Coronary Heart Disease in Women (R01 HL079123): This is an ancillary study of SWHS aiming to test the hypothesis that soy food consumption decreases the risk of coronary heart disease (CHD) and CHD-related death, particularly among women who have a high risk of developing CHD. This study includes two components: 1) a longitudinal analysis of dietary soy intake and CHD risk; 2) a nested case-control study evaluating the association of urinary isoflavonoid levels, biomarkers of soy intake, with CHD risk. The modification effect of blood lipid profile and C-reactive protein, known risk factors for CHD, on the soy-CHD association will also be evaluated.
• Shanghai Breast Cancer Study (R01 CA64277, R01 CA90899): This is an ongoing study funded since 1996 to investigate genetic and lifestyle factors as well as other biomarkers for breast cancer risk and survival. Included in the study are approximately 3,500 breast cancer cases and an equal number of community controls recruited among female residents of Shanghai, China. In addition to in-person interview data, biological samples have also been collected from study participants. The resources from the study have supported multiple externally funded research and training grants. To date, over 100 research papers have been published on the SBCS addressing a wide range of significant issues related to breast cancer risk and survival. A genome-wide association study of breast cancer (R01 CA124558) has been recently launched using the resources of this study and Shanghai Breast Cancer Survival Study.

Housing Availability:
SMCDCP will assist with finding an apartment, furniture, and other necessities. The apartment will be located within 3 miles of transportation to SMCDCP (20-30 minutes bus ride). Monthly costs for room, board, and transportation average about 1200 USD/person.

Health Issues and Immunizations Needed for this Site:
See the Centers for Disease Control and Prevention Web site and The Yellow Book: Health Information for International Travel.

The FICRS program mandates that all Scholars see a physician prior to their assignment abroad. The site will require a formal letter from your physician stating that you have received the necessary immunizations prior to the start of your fellowship.

Safety and Danger Issues:
See the U.S. State Department Web site for information.

Language Requirements other than English:
Most researchers at the SMCDCP can communicate in spoken and written English. There are professional language schools for foreigners to learn Chinese in Shanghai. Payment of tuition for such programs will be the responsibility of the trainee.

What is it like to live in China?

Working and living in Shanghai is an unprecedented opportunity to live abroad while engaging in critical issues of emerging health risks associated with modernization. An important center of commerce and finance and the world's largest port, Shanghai, a city of over 18 million residents, is located on the central eastern coast of China. As a melting pot of Chinese and Western cultures, Shanghai offers great opportunities to explore the rich history and culture of China while enjoying the best of global trends and Western comforts. Hanzhou and Suzhou, two of China's most historic and scenic cities, are located only 1.5 hours away. Direct flights are available to most major cities in China, and overnight express trains run regularly to Beijing, China's burgeoning capital.