A couple-based unmet supportive care needs intervention for colorectal cancer couples: A preliminary feasibility study.

PURPOSE: To support colorectal cancer couples cope with cancer, we developed a couple-based unmet supportive care needs intervention program guided by the Supportive Care Needs Framework and examined the feasibility, acceptability, and initial effects of the unmet supportive care needs program. METHODS: The design of a pre-and post-intervention study was conducted among Chinese colorectal cancer couples. The intervention was delivered in five sessions through in-person and telephone interventions combined. To measure program feasibility through recruitment and retention rates, and to test program acceptability through quantitative and qualitative post-intervention program assessments. The complete data (N = 20 pairs) were used to calculate effect sizes to assess the initial intervention effect. RESULTS: There was evidence of the feasibility of the intervention program in terms of recruitment (66.7%) and retention (83.3%) rates. Participants' satisfaction with the program also attested to its acceptability. The intervention (Cohen's = 0.15-0.56) had a small-moderate effect size in improving unmet supportive care needs and most cancer-adapted outcomes for colorectal cancer couples, validating the initial effect of the program. CONCLUSIONS: The unmet supportive care needs program is feasible, acceptable, and preliminarily effective in supporting Chinese colorectal cancer couples to improve unmet supportive care needs and cancer adaptability, as provided by this study.

Impact of global value chain embedding on decoupling between China's CO2 emissions and economic growth: Based on Tapio decoupling and structural decomposition.

With the increasing fragmentation of global production, China's participation in cross-border production sharing activities has had a considerable impact on the nation's economy and carbon dioxide (CO2) emissions. This study applied the Tapio model to quantitatively evaluate the decoupling between CO2 emissions and economic growth in China, dividing the decoupling index based on global value chains (GVCs) and domestic production within the IO framework, and introducing structural decomposition analysis (SDA) to analyze the GVC-related factors to the decoupling. The relevant research results are fourfold. (1) From 2000 to 2018, China achieved weak decoupling between emissions and economic growth. Domestic and GVC effects each had a negative impact on the decoupling; however, after 2008, the GVC effect had a promotional effect and the negative domestic effect declined. (2) Emission intensity was the primary factor promoting decoupling through domestic and GVC effects, while the scale of final demand was the main hindrance. And the negative effects of GVC-related factors declined following the economic crisis. (3) The regional and sectoral structures of GVC production (58.44 % and 56.08 %) had promotional roles in the changes in GVC effects, while GVC production linkages (-20.19 %) had hindering effects. Various factors contributed to the hindering effect from the 2008 to 2011 index, whereas from the 2011 to 2018 index, all factors contributed to the promotional effect. (4) From 2000 to 2018, the average annual global value chain effect promoted the low-carbon development of China's labor-intensive and knowledge-based manufacturing. In order for GVCs to play a positive role in decoupling, China should promote trade facilitation through international platforms, support the advancement of production technology, reasonably guide China's industries to participate in the regional and industrial links of GVCs, and develop strategic emerging industries.

Weighing China's embodied CO2 emissions and value added under global value chains: Trends, characteristics, and paths.

With the accelerated expansion of global value chains (GVCs), China occupies an increasingly important position in the global production division system, which has important impacts for its economy and environment. Comprehensively measuring the economic benefits and emissions costs of China's participation in GVCs, and striving to achieve a mutually beneficial state of GVC upgrade and low-carbon economic development, are critical issues for China. This study applies the accounting framework of value-added trade and embodied CO2 emission trade to measure the potential CO2 emissions cost of China's value-added gains through traditional trade, simple GVC, and complex GVC from 2000 to 2014. The findings are fourfold. (1) Compared with traditional trade, GVC-related activities require higher carbon emissions costs to obtain value added, which exacerbates China's economic-environmental imbalance. (2) Electricity, Metals, and Non-metallic mineral industries are the primary sectors of embodied CO2 emissions exports, and they bear heavy emissions pressure while obtaining limited value added. (3) China's embodied CO2 trade and value-added trade with developing countries through GVCs are rising, whereas the trade with developed countries reveals a downward trend. (4) The characteristics of China's industrial paths under different trade routes vary considerably. CO2 emissions in the industrial path of GVC-related activities are more hidden, and comprehensive management must be carried out throughout the entire industrial chain from production to consumption. This study proposes policy recommendations for the coordinated development of economic and environmental relations, such as reducing the carbon intensity of key industries, strengthening trade cooperation with emerging economies, and enhancing China's position in GVCs.

A nationwide survey on neonatal medical resources in mainland China: current status and future challenges.

BACKGROUND: With the rapid development of economy in recent two decades, neonatology has been progressing quickly in China. However, there is little knowledge about the exact developmental status of neonatal departments in China. The aim of this study was to assess resources available for care of sick newborns in mainland China. METHODS: Questionnaires were sent to the membership of the Chinese Neonatologist Association (CNA) and used to survey the scale, facilities, staff, technologies, transport systems and preterm infants' outcomes of neonatal departments (NDs) in different areas of China from June 2012 to December 2012. RESULTS: The result of this survey including a total of 117 questionnaires showed that investigated ND had a mean of 65 (median 47; range 5-450) beds, including 19.59 (median 15, range 0-100) NICU beds. The overall doctor/bed and nurse/bed ratio was 1:3.84 and 1:1.43, respectively. Lack of medical equipment was one of the main problems in most NDs surveyed, and only 26 NDs (22.2%) had more than one neonatal incubator per bed. Only 70.1, 30.6, 30.8 and 4.3% NDs carried out high-frequency ventilation, hypothermia, nitric oxide inhalation, and ECMO respectively. The capacity to provide advanced therapies increased with the size of the NDs (P < .01). A total of 81 NDs (69.2%) carried out neonatal transport, but only 70 NDs (86.4%) were equipped with transport incubators, 36 NDs (44.4%) had the ability of performing intrauterine transport of the preterm infants, and 3 NDs (3.7%) had the ability of performing air transport. The survival rate of extremely preterm infants (Gestational age less than 28w) to discharge home was 47.8% in 2011. CONCLUSION: NDs in mainland China are not well distributed and still face many problems, such as staff shortage, inadequate facilities, and imperfect transport. It is urgent to set up a classification of neonatal care to enhance the utilization rate of medical resources and improve the prognosis of critically ill infants.

China's provincial CO2 emissions and interprovincial transfer caused by investment demand.

Based on the China's 1997, 2002, 2007, and 2012 multiregional input-output model, this study calculates China's provincial CO2 emissions from investment demand and interprovincial transfer of CO2 emissions caused by investment demand. The findings of this study are as follows: (1) From 1997 to 2012, the CO2 emissions from China's investment demand have seen rapid growth-the CO2 emissions from investment demand has increased by 4.52 times, and the per capita CO2 emissions caused by investment demand has increased by 4.13 times. Investment demand is an important driver of growth of China's CO2 emissions. The proportion of CO2 emissions from investment demand in CO2 emissions from China's three final demands rose from 37.72% in 1997 to 50.68% in 2012. (2) The CO2 emissions from investment demand are relatively large in provinces which have large-scale industries. Affected by investment-driven economic growth, CO2 emissions from investment demand in central, western, and northeastern provinces have increased more rapidly. (3) Large amounts of CO2 are emitted in the less-developed central and western provinces to meet the investment demand of the developed eastern provinces. As China's economy enters the "new normal," economic growth is shifting from investment-driven to consumption-driven, and the growth of CO2 emissions from investment demand will slow down.

Supportive care needs and associated factors among Chinese cancer survivors: a cross-sectional study.

PURPOSE: To investigate the unmet supportive care needs (SCNs) of Chinese cancer survivors and to identify factors associated with the unmet SCNs of cancer survivors. METHODS: A cross-sectional survey of Chinese cancer survivors was conducted using validated scales of the Cancer Survivors Unmet Needs scale (CaSUN), physical symptom concerns (Cancer Survivors Survey of Needs-CSSN subscale), and a single-item measure of global quality of life (QoL) perception. RESULTS: There were 330 participants, with a mean score of 7.1 (0-10) in overall QoL. The reported rate of the 19 symptom concerns ranged from 19.4 to 72.2%. The level of unmet SCNs (moderate and strong need) ranged from 12.1 to 59.1%. The top five unmet needs included concerns about the cancer re-occurring (59.1%), accessing the best medical care (52.7%), accessing complementary therapy services (51.5%), changes to beliefs (48.2%), and survivor expectations (47.6%). The strength of unmet SCNs was negatively correlated with participant age (P < 0.05), average time since diagnosis (P < 0.05), and overall QoL (P < 0.01) and positively correlated with all symptom concerns (all P < 0.001). CONCLUSIONS: Study findings call attention to cancer survivors' unmet SCNs and related factors. Underscored areas in developing survivorship care included paying special attention to existential survivorship, empowering survivor management of chronic symptoms, particularly for younger survivors, as well as for survivors with poor QoL, and those with a shorter time since diagnosis. This tailored survivorship care should be developed and delivered by a multidisciplinary team to support cancer services, with a greater capacity to deliver individualized, unmet SCN-driven care to survivors.

The Assessment of Diagnostic Accuracy for Basilar Artery Stenosis by Transcranial Color-Coded Sonography.

This study aimed to determine the optimal criteria for evaluating basilar artery stenosis (BAS) by transcranial color-coded sonography (TCCS). A total of 403 cases with both TCCS and digital subtraction angiography (DSA) were enrolled. Peak systolic velocity (PSV), end diastolic velocity (EDV) and mean flow velocity (MFV) of the basilar artery (BA), intracranial vertebral artery (IVA) and posterior cerebral artery (PCA) were measured. The ratios PSVBA/PSVIVA and PSVBA/PSVPCA were calculated. With DSA as the reference, the optimal criteria for grading BAS were determined by receiver operating characteristic analysis. They were as follows: PSV ≥110 cm/s, MFV ≥70 cm/s and PSVBA/PSVIVA ≥1.5 for <50% BAS; PSV ≥150 cm/s, MFV ≥90 cm/s and PSVBA/PSVIVA ≥2.0 for 50%-69% BAS; PSV ≥210 cm/s, MFV ≥120 cm/s and PSVBA/PSVIVA ≥3.0 for 70%-99% BAS. The combination of PSV, MFV and PSVBA/PSVIVA may increase the accuracy for diagnosing 70%-99% BAS.

Application of case mix index in the allocation of nursing human resources.

AIM: To investigate the feasibility of the case mix index and compare the allocation of nursing human resources between two departments of a hospital with different case mix indexes in China. BACKGROUND: The case mix index is used to assess the resource allocation of all cases in two departments of a hospital. Its values can determine the resource allocation required to diagnose and treat the patients. METHODS: Clinical data were obtained from 23 different departments in 2015 and analysed retrospectively from October to November, 2016. Factors influencing the allocation of registered nurses were identified, and balanced quantities of patients with different case mix indexes were chosen from two departments. Spearman correlation analysis was performed. RESULTS: The per capita nursing workload was significant (r = .669, p = .000). The length of hospital stay, quantity of nurses, and department case mix index were correlated with the nursing workload (t = 4.211, p = .000; t = 2.962, p = .008; t = 2.266, p = .035). Education levels (Z = -1.391, p = .164) and the professional titles (Z = -1.832, p = .067) of the nurses were not statistically significant, whereas the registered nurse level differed between two departments (Z = -2.125, p = .034). CONCLUSION: The case management index provides references for the efficient allocation of registered nurses in clinical practice.

Testing a Preliminary Live with Love Conceptual Framework for cancer couple dyads: A mixed-methods study.

PURPOSE: The purpose of this study was to test the previous proposed Preliminary Live with Love Conceptual Framework (P-LLCF) that focuses on spousal caregiver-patient couples in their journey of coping with cancer as dyads. METHODS: A mixed-methods study that included qualitative and quantitative approaches was conducted. Methods of concept and theory analysis, and structural equation modeling (SEM) were applied in testing the P-LLCF. RESULTS: In the qualitative approach in testing the concepts included in the P-LLCF, a comparison was made between the P-LLCF with a preliminary conceptual framework derived from focus group interviews among Chinese couples' coping with cancer. The comparison showed that the concepts identified in the P-LLCF are relevant to the phenomenon under scrutiny, and attributes of the concepts are consistent with those identified among Chinese cancer couple dyads. In the quantitative study, 117 cancer couples were recruited. The findings showed that inter-relationships exist among the components included in the P-LLCF: event situation, dyadic mediators, dyadic appraisal, dyadic coping, and dyadic outcomes. In that the event situation will impact the dyadic outcomes directly or indirectly through Dyadic Mediators. The dyadic mediators, dyadic appraisal, and dyadic coping are interrelated and work together to benefit the dyadic outcomes. CONCLUSIONS: This study provides evidence that supports the interlinked components and the relationship included in the P-LLCF. The findings of this study are important in that they provide healthcare professionals with guidance and directions according to the P-LLCF on how to plan supportive programs for couples coping with cancer.

The assessment of health-related quality of life and related factors in Chinese elderly patients undergoing chemotherapy for advanced cancer: a cross-sectional study.

PURPOSE OF THE RESEARCH: (i) To assess the health-related quality of life (HRQOL) and analyse the potential contributing factors of HRQOL in elderly cancer patients in China; and (ii) to evaluate the possible correlation between the Medical Outcomes 36-Item Short Form Health Survey (SF-36) and the European Organization for Research and Treatment of Cancer, quality of life questionnaire (EORTC QLQ-C30). METHODS AND SAMPLE: A total of 109 elderly patients undergoing chemotherapy with advanced cancer completed a survey assessing HRQOL, anxiety and depression. HRQOL was measured by SF-36 and EORTC QLQ-C30. Anxiety and depression, was measured by the Hospital Anxiety and Depression Scale (HADS). KEY RESULTS: Scales pertaining to role functioning, including SF-36 role physical (25.92 ± 37.10) and role emotional (36.12 ± 43.50), EORTC QLQ-C30 role functioning (46.94 ± 36.86), were the worst domains of SF-36 and EORTC QLQ-C30 respectively. Financial impact (55.77 ± 36.55) and fatigue (46.18 ± 26.48) were the top two highest scores among all nine symptom-related scales of EORTC QLQ C-30. The correlation matrix of SF-36 versus EORTC QLQ-C30 showed that, in general, there was good correlation between scales pertaining to the same health domain, and low correlation was observed between scales pertaining to different domains. CONCLUSIONS: The findings of this study highlight role functioning, financial impact, fatigue, anxiety, and depression as areas where elderly cancer patients could most benefit from intervention. These findings also call attention to HRQOL and its related factors in elderly cancer patients. Interventions to be developed for improving HRQOL in cancer patients are highly recommended.