Outcomes In China Research Articles

How Chinese Doctors Do Things With Discursive Strategies in Palliative Care Family Meetings: A Genre Theory Analysis

ABSTRACT Palliative care family meetings (PCFMs) can be conceivably endorsed as helpful means for bettering end of life (EOL) communication with terminally ill patients and their families. Relevant scholarship in China remains emerging and youthful, with many avenues left to explore. Few studies have delineated the structure and specified the strategies for conducting PCFMs in the Chinese context. To address this gap, this study gathered data from audio-recorded family meetings held in palliative care wards in China. Within the theoretical framework of genre theory in functional linguistics (FL) that defined genres as staged, goal-oriented social processes, utilizing thematic analysis and discourse analysis, the twofold generic structure of PCFMs was delineated, consisting of four genre stagings in the upper stratum and fourteen elemental genres in the lower stratum, with the identified attributes of elemental genres, their sequence and possibility of iteration. Doctors’ discursive strategies in terms of semantics and lexicogrammar were specified as they serve to achieve communicative goals regarding knowledge, identity, and emotion. It is hoped that the results will improve the context for growing palliative care practices and positive clinical outcomes in China and provide insights into the structurization and discursiveness of practices in EOL settings.

Heterogeneous Trajectories of Parental Psychological Aggression from Middle Childhood to Early Adolescence in China: Associations with Child- and Family-Level Predictors and Children's Developmental Outcomes.

Previous research has shown that parental psychological aggression may change with children's age, and individual differences existed in the developmental trajectories of parental psychological aggression within different families. However, most studies on the heterogeneous psychological aggression trajectories have focused solely on mothers or combined mothers' and fathers' data, with few studies separately exploring the unique trajectories of fathers and mothers and their predictors and outcomes within Chinese societies. Therefore, this study investigated the heterogeneous trajectories of paternal and maternal psychological aggression from middle childhood to early adolescence and their associations with child- and family-level predictors and outcomes in China. A total of 1137 Chinese families with children in grades 1-3 (Mage = 7.17; SDage = 0.95 at Time 1; 52.35% boys, 47.65% girls) participated in assessments at five time points, using 1-year internals in between. Latent class growth models were used to estimate the heterogeneous trajectories of paternal and maternal psychological aggression from ages 7 to 11 years. Logistic regression analyses were used to understand the child- and family-level predictors of these trajectories, and analysis of covariance was used to examine the outcomes of these trajectories. The findings revealed that three trajectories of paternal psychological aggression were identified: low-persistent (88.95%), high-decreasing (7.93%), and high-increasing-decreasing (3.12%) trajectories. Four trajectories of maternal psychological aggression were identified: low-persistent (86.17%), high-decreasing (5.94%), high-increasing-decreasing (4.08%), and low-increasing (3.81%) trajectories. Lower marital satisfaction, more psychological aggression experiences during childhood, and being a parent of a boy were risk factors for both paternal and maternal trajectories, while higher negative affectivity in children was a risk factor of maternal but not paternal trajectories. In addition, the high-increasing-decreasing trajectory for both fathers and mothers as well as the low-increasing trajectory for mothers predicted children's more internalizing and externalizing problems. These findings highlight the importance of considering heterogeneity in understanding the developmental patterns of parental psychological aggression, their predictors, and cumulative effects on child development.

Unintended consequences of maternity leave entitlements on female labor market outcomes in China

This study provides the first empirical evidence of the impact of maternity leave entitlements on labor market outcomes for women of childbearing age in urban China. We exploit a reform during which approximately two-thirds of the provinces in China extended their leave entitlements from 2014 to 2016 and employ a triple-difference strategy to deal with the identification. The results suggest unintended effects, as leave entitlement extensions led to a reduction in the likelihood of working, formal employment, and wage for women of childbearing age relative to their counterparts. We further establish that greater reliance on employer liability may be the main mechanism behind the unintended effects, highlighting the importance of payment schemes. This study provides novel evidence and mechanisms for the labor market effect of maternity leave in women of childbearing age and provides new insights for maternity leave related policy designs.

Treatment and survival of non-metastatic small cell carcinoma of the bladder from multiple centers in China

Small cell carcinoma of the bladder (SCCB) is a rare, highly malignant neuroendocrine tumor. This study attempted to analyze tumor characteristics, treatments and clinical outcomes in China. We conducted a retrospective analysis of patients diagnosed with non-metastatic SCCB at multi-institutions between January 2007 and January 2022. The Kaplan-Meier method was used to calculate survival. A total of 20 patients were included. 10 had localized disease (T1-2N0), and 10 had locally advanced disease (≥ T3 or N+). 13 received local treatment (partial cystectomy or transurethral resection of the bladder tumor) and 7 received radical treatment (radical cystectomy or radiotherapy). A total of 18 patients (90%) received chemotherapy (CT), either neoadjuvant CT (n = 5) or adjuvant CT (n = 13). The median OS for the receiving local treatment was 65.3 months (95% CI 0 to 138 months) and the corresponding 1-year, 2-year, and 3-year OS was 77%, 54%, and 54%, respectively. The median OS for the receiving radical treatment was not reached and the corresponding 1-year, 2-year, and 3-year OS was 100%, 100%, and 75%, respectively. The median PFS for receiving local treatment was 13.8 months (95% CI 9.3 to 18.3 months) and the corresponding 1-year, 2-year, and 3-year PFS was 46%, 31%, and 31%, respectively. The median PFS for the receiving radical treatment was not reached and the corresponding 1-year, 2-year, and 3-year PFS was 83%, 56%, and 56%, respectively. This study reported the largest cohort of non-metastatic SCCB among Chinese population. Given its metastatic potential, CT remained an essential part of the treatment. The survival outcomes of radical cystectomy and RT in non-metastatic SCCB were encouraging.

When cancer patients encountered COVID-19: clinical characteristics and outcome in China.

Cancer patients were more likely to be affected by the coronavirus disease 2019 (COVID-19) pandemic. Therefore, we analyzed the clinical characteristics and outcomes in cancer patients who were infected with COVID-19 to determine if they were more vulnerable to COVID-19 than non-cancer patients. This retrospective study involved 150 cancer patients and 300 non-cancer patients with a laboratory-confirmed diagnosis of COVID-19 at the Cancer Hospital of the Chinese Academy of Medical Sciences, at the end of 2022. Multivariable analysis was carried out on the factors associated with COVID-19 severity in cancer patients. Compared to the non-cancer group, the cancer group saw a notably higher number of hospitalizations and fatalities. Multivariate analysis showed that COVID-19 severity was correlated with male gender (OR: 5.60, 95% CI, 1.89-16.57), and recovery duration was longer than 10 days (OR: 3.19, 95% CI, 1.09-9.32) in the cancer group. However, the severity of COVID-19 was not made worse by the administration of systemic anticancer treatments prior to the outbreak. During the COVID-19 Omicron epidemic, there seemed to be some association between various antitumor therapies, treatment intervals, and COVID-19 severity. The findings of this study can potentially help allay cancer patients` fears regarding COVID-19 infection and enable them to continue with crucial therapeutic processes for the treatment of cancer.

Hukou Stratification and Job Precariousness between the State and Market Sectors in Contemporary China, 2010–2021

Echoing the global expansion of precarious employment, China has experienced a surge in labor flexibility and job deterioration since its integration into global capitalism. Existing research also highlighted the distinct features of the Chinese labor market related to its post-socialist nature. The Chinese household registration system, known as hukou, has been critical in explaining stratification and shaping labor market outcomes in China. However, hukou reforms in the recent decade have further relaxed restrictions on labor mobility and hukou conversion, suggesting that hukou may gradually lose its importance in transitional China. Building upon the global research on precarious work and dynamics of precariousness in employment in the Chinese context, I conceptualize job precariousness in the contemporary Chinese labor market in three dimensions. Using pooled data from the 2010 to 2021 Chinese General Social Survey, I examine how hukou stratification is associated with the three aspects of job precariousness, compare the relative importance of hukou with other market-related factors, and identify the disparities of the state and market sectors. The findings help contextualize global trends of precariousness by broadening the evidence base through a case in China.

Influence of Internet Use on Happiness in China: Mediating Effects of Environmental Quality Perception and Moderating Role of Sense of Environmental Security.

This study aims to comprehensively examine the effects of different types of Internet use and happiness while considering the mediating role of environmental quality perception and the moderating role of a sense of environmental security. Drawing on the uses and gratifications theory, negativity bias, and social cognitive theory, the study investigates the mediating role of environmental quality perception and the moderating role of environmental security in the above relationship. Using data from 3162 respondents in the 2021 Chinese Social Survey (CSS) and Structural Equation Modeling (SEM), the study finds that Internet use for information and educational purposes significantly enhances happiness, with environmental quality perception acting as a mediator. Moreover, a moderating effect of environmental security was observed in the relationship between Internet use for educational purposes and national environmental quality perception. Specifically, the interaction between study-related Internet use and the sense of environmental security significantly and positively predicted national environmental quality perception. These findings highlight the complex interaction between Internet use, environmental factors, and happiness, offering insights into policy interventions aimed at improving Internet access and environmental awareness to enhance public mental health outcomes in China.

Endoscopic dacryocystorhinostomy in acute dacryocystitis: a multicenter study in China.

To report the clinical profile, endoscopic dacryocystorhinostomy (En-DCR) management, and acute dacryocystitis (AD) outcomes in China. Clinical data of 554 adult AD patients (554 eyes) who presented in 7 tertiary eye care centers for 10y from Jan 2010 to Mar 2020 were retrospectively analyzed. Clinical profile, En-DCR management, and outcomes of all cases were recorded. The anatomical and functional success were evaluated for 12mo post-operation. The analysis included 149 males and 368 females with a median age of 55.2y (range: 18-84y). There were 459 eyes with a history of epiphora or purulent secretion. The time between a symptom of lacrimal duct obstruction and acute onset was 1 to 540 (66.1±58.2)mo. Fifty-nine eyes had a history of the previous acute attack. Seventy-four eyes developed a cutaneous fistula, while 11 eyes had post septal cellulitis pre-operation. En-DCR with an anatomical success of 91.7% and functional success of 90.1%. The success rate of the patients with a history of acute episodes and the preoperative fistula was lower than the overall success rates. En-DCR can be performed during an acute episode in AD with a success rate of over 90%.

The efficiency of residency training and health outcomes in China: Based on two-stage DEA and cluster analysis

To address the residency training performance and further explore its determinants, with the help of a unique dataset, our study calculated the efficiency of residency training and health outcomes in 18 Chinese tertiary hospitals from 2020 to 2021 using a two-stage data envelopment analysis (DEA) model given the two-stage characteristics of vocational training and clinical practice of residents. The results showed that the efficiency of the sample hospitals in both residency training and medical service provision was high, there are approximately 1/3 hospitals of sub-efficient in each stage, but the number of efficient units for assessing the residency training performance was slightly less than that for assessing the health outcome performance. All the decision-making units (DMUs) were clustered into four groups through K-means cluster analysis according to efficiency results. The results showed that there was an obvious inconsistency between the teaching goals and the health outcome goals of Chinese public hospitals. In some hospitals, the low residency pass rate resulted in the low efficiency in stage 1, while the redundant inputs in beds resulted in the low efficiency in stage 2. Residency training hospitals should strengthen their synergistic management in programs of residency training and health outcomes.

Out-of-pocket medical expenditures, remittances and health outcomes in China.

This study examines the relationship between out-of-pocket medical expenditures, remittances and health outcomes in China using Ordinary Least Squares (OLS) and Propensity Score Matching (PSM) methods. The analysis is based on data from the Global Financial Inclusion database by the World Bank (2021), encompassing a sample of 3,446 individuals. The results indicate that out of-pocket expenditure has a negative impact on health outcomes, while remittance shows a positive association across all age groups, including reproductive and non-reproductive populations. These findings suggest that high out-of-pocket medical costs may hinder access to healthcare services and lead to poorer health outcomes. Conversely, remittance plays a beneficial role in improving health outcomes, highlighting the potential of financial support to positively impact the well-being of individuals.

The effect of long-term care insurance on women’s health outcomes in China: evidence from a disability inclusion action

BackgroundLong-term care insurance (LTCI) in China provides financial and care security for persons with disabilities and includes caregivers in the paid labour workforce. However, it is unclear how the LTCI affects health outcomes in female recipients, female caregivers, and female non-recipients and female non-caregivers.MethodsUsing the China Health and Retirement Longitudinal Study data and staggered difference-in-differences method, we evaluated the effect of LTCI on health outcomes in women with different roles, including female recipients, female caregivers, and female non-recipients and female non-caregivers, and discussed the heterogeneity of the effect on women’s health outcomes.ResultsLTCI statistically significant increased self-rated health and reduced depression in women and improved the health in women with different roles by increasing self-rated health in female recipients, reducing chronic diseases in female caregivers, and reducing depression in female non-recipients and female non-caregivers. There was a more pronounced improvement in health outcomes among women in the west and northeast and women in rural village.ConclusionsAfter the implementation of LTCI, health outcomes in female recipients, female caregivers, and female non-recipients and female non-caregivers were improved. LTCI’ improvement on women’s health outcomes was heterogeneous geographically and socially. Our findings highlight the importance of delivering differentiated health interventions for women with different roles in the implementation process of LTCI and minimizing women’s health inequalities in geography and society.

Social environment, health cognition, and health behavior: how individuals with non-fixed employment end up with adverse health outcomes in China under the era of VUCA?-findings from PLS-SEM and fsQCA.

This article studied the single-factor causal relationships between the social environment, health cognition, and health behavior of the individuals with non-fixed employment and their adverse health outcomes, as well as the complex causal relationships of multiple factors on these outcomes. Partial Least Squares Structural Equation Modeling (PLS-SEM) and Fuzzy-Set Qualitative Comparative Analysis (fsQCA) are employed. Data is collected from the results of an open questionnaire Psychology and Behavior Investigation of Chinese Residents 2021. PLS-SEM analysis reveals that health risk behaviors and cognition play a mediating role in impact of the social environment on adverse health outcomes, indicating that individuals with non-fixed employment susceptible to adverse health outcomes. fsQCA analysis identifies that weak social support is a core condition leading to outcomes of depression and anxiety. There are shared configurations and causal pathways between the outcomes of physical health and depression. The study supports the social determinants theory of health and suggests that the fundamental reason for people being trapped in adverse health outcomes is the health inequality caused by social stratification, and the external shock of uncertainty in the era of VUCA (Volatility, Uncertainty, Complexity, and Ambiguity).

Doctoral students’ research motivation and outcomes in China: training environment moderation

Doctoral students’ research motivation and outcomes in China: training environment moderation

The Costs of Zero-Covid: Effects of Anti-contagious Policy on Labor Market Outcomes in China

The Costs of Zero-Covid: Effects of Anti-contagious Policy on Labor Market Outcomes in China

Notable dysthymia: evolving trends of major depressive disorders and dysthymia in China from 1990 to 2019, and projections until 2030

BackgroundDepressive disorders have been identified as a significant contributor to non-fatal health loss in China. Among the various subtypes of depressive disorders, dysthymia is gaining attention due to its similarity in clinical severity and disability to major depressive disorders (MDD). However, national epidemiological data on the burden of disease and risk factors of MDD and dysthymia in China are scarce.MethodsThis study aimed to evaluate and compare the incidence, prevalence, and disability-adjusted life-years (DALYs) caused by MDD and dysthymia in China between 1990 and 2019. The temporal trends of the depressive disorder burden were evaluated using the average annual percentage change. The comparative risk assessment framework was used to estimate the proportion of DALYs attributed to risk factors, and a Bayesian age-period-cohort model was applied to project the burden of depressive disorders.ResultsFrom 1990 to 2019, the overall age-standardized estimates of dysthymia in China remained stable, while MDD showed a decreasing trend. Since 2006, the raw prevalence of dysthymia exceeded that of MDD for the first time, and increased alternately with MDD in recent years. Moreover, while the prevalence and burden of MDD decreased in younger age groups, it increased in the aged population. In contrast, the prevalence and burden of dysthymia remained stable across different ages. In females, 11.34% of the DALYs attributable to depressive disorders in 2019 in China were caused by intimate partner violence, which has increasingly become prominent among older women. From 2020 to 2030, the age-standardized incidence, prevalence, and DALYs of dysthymia in China are projected to remain stable, while MDD is expected to continue declining.ConclusionsTo reduce the burden of depressive disorders in China, more attention and targeted strategies are needed for dysthymia. It’s also urgent to control potential risk factors like intimate partner violence and develop intervention strategies for older women. These efforts are crucial for improving mental health outcomes in China.

A nationwide study on new onset atrial fibrillation risk factors and its association with hospital mortality in sepsis patients

Atrial fibrillation (AF) is the most common arrhythmia and its incidence increases with sepsis. However, data on new-onset AF during sepsis hospitalization remain limited in China. We aimed to evaluate the incidence, risk factors, and associated mortality of new-onset AF in sepsis patients in China. We conducted a retrospective study using the National Data Center for Medical Service system, from 1923 tertiary and 2363 secondary hospitals from 31 provinces in China from 2017 to 2019.In total we included 1,425,055 sepsis patients ≥ 18 years without prior AF. The incidence of new-onset AF was 1.49%. Older age, male sex, hypertension, heart failure, coronary disease, valvular disease, and mechanical ventilation were independent risk factor. New-onset AF was associated with a slight increased risk of mortality (adjusted RR 1.03, 95% CI 1.01–1.06). Population attributable fraction suggested AF accounted for 0.2% of sepsis deaths. In this large nationwide cohort, new-onset AF occurred in 1.49% of sepsis admissions and was associated with a small mortality increase. Further research should examine whether optimized AF management can improve sepsis outcomes in China.

Examining health apps and wearable use in improving physical and mental well-being across U.S., China, and Singapore

Health apps and wearables are touted to improve physical health and mental well-being. However, it is unclear from existing research the extent to which these health technologies are efficacious in improving physical and mental well-being at a population level, particularly for the underserved groups from the perspective of health equity and social determinants. Also, it is unclear if the relationship between health apps and wearables use and physical and mental well-being differs across individualistic, collectivistic, and a mix of individual–collectivistic cultures. A large-scale online survey was conducted in the U.S. (individualist culture), China (collectivist culture), and Singapore (mix of individual–collectivist culture) using quota sampling after obtaining ethical approval from the Institutional Review Board (IRB-2021-262) of Nanyang Technological University (NTU), Singapore. There was a total of 1004 respondents from the U.S., 1072 from China, and 1017 from Singapore. Data were analyzed using multiple regression and negative binomial regression. The study found that income consistently had the strongest relationship with physical and mental well-being measures in all three countries, while the use of health apps and wearables only had a moderate association with psychological well-being only in the US. Health apps and wearables were associated with the number of times people spent exercising and some mental health outcomes in China and Singapore, but they were only positively associated with psychological well-being in the US. The study emphasizes the importance of considering the social determinants, social–cultural context of the population, and the facilitating conditions for the effective use of digital health technologies. The study suggests that the combined use of both health apps and wearables is most strongly associated with better physical and mental health, though this association is less pronounced when individuals use only apps or wearables.

Macro-level gender inequality and child health outcomes in China

Few studies have evaluated the potential impact of macro-level gender inequality on child development. Using data from the 2010 China Family Panel Studies, this study investigates whether and how county-level gender inequality affects children’s health outcomes in China. Results show that greater exposure to county-level sexism is associated with worse mental and physical health among both boys and girls in China. On the one hand, the greater the county-level gender inequality, the worse the depression symptoms and the lower the standardized height among children in this region. In addition, exposure to county-level gender inequality leads to a greater negative effect on mental health among girls than among boys. On the other hand, county-level gender inequality also imposes a greater negative effect on depression symptoms among children from families with a lower socioeconomic status along with an increasing harm on height as children grow older. Further analysis unveils the psychosocial mechanisms and the mechanism of access to family resources underlying the health effects of such exposure to macro-level gender inequality.

Status of the midwifery workforce and childbirth services and the impact of midwife staffing on birth outcomes in China: a multicentre cross-sectional study

ObjectiveTo investigate the status of the midwifery workforce and childbirth services in China and to identify the association between midwife staffing and childbirth outcomes.DesignA descriptive, multicentre cross-sectional survey.SettingMaternity hospitals from...

Garlic-specific Fertilizer Improves Economic and Environmental Outcomes in China

Traditional methods of garlic fertilization involve large amounts of balanced fertilizer with equal proportions of N, P, and K, leading to nutrient imbalances, reduced yield and nutritional quality, and elevated risk of environmental pollution. This study for the first time measured garlic nutrient absorption and mineral elements status in garlic fields. In addition, a garlic-specific fertilizer formula and recommended rate were designed and applied in multiple garlic fields during the 2019–21 growing season. We assessed the performance of garlic-specific fertilizer in terms of yield, quality, and nutrient utilization efficiency. We showed that garlic prefers to absorb N and K, and its absorption of P was much lower. Deficiencies in Cl, Mn, S, and Fe are found in 98.7%, 56.1%, 22.8%, and 11.9% of garlic fields. Compared with farmer fertilization, the garlic-specific fertilizers increased sprout yield by 12.9% to 30.5%, bulb yield by 11.0% to 33.5%, and net income by 18.2% to 45.6%. Furthermore, it improved the nutritional quality [vitamin C (Vc), soluble sugar (SS), and soluble protein] of the garlic and reduced the accumulation of nitrate. The formula of special fertilizer was more in line with the law of garlic nutrient absorption, increasing the nutrient utilization effect, reducing the environmental risks. Application of specific fertilizer increased N, P, and K partial productivity by 26.6% to 50.1%, 82.6% to 116.5%, and 54.6% to 83.3%, respectively. These results suggest that replacing balanced fertilizers in the garlic market with garlic-specific fertilizers can improve garlic farmers' incomes and soil health.