Schizophrenia is a leading cause of disability, and a shift from facility- to community-based care has been proposed to meet the resource challenges of mental healthcare in low- and middle-income countries. We hypothesized that the addition of mobile texting would improve schizophrenia care in a resource-poor community setting compared with a community-based free-medicine program alone. In this 2-arm randomized controlled trial, 278 community-dwelling villagers (patient participants) were randomly selected from people with schizophrenia from 9 townships of Hunan, China, and were randomized 1:1 into 2 groups. The program participants were recruited between May 1, 2015, and August 31, 2015, and the intervention and follow-up took place between December 15, 2015, and July 1, 2016. Baseline characteristics of the 2 groups were similar. The patients were on average 46 years of age, had 7 years of education, had a duration of schizophrenia of 18 years with minimal to mild symptoms and nearly one-fifth loss of functioning, and were mostly living with family (95%) and had low incomes. Both the intervention and the control groups received a nationwide community-based mental health program that provided free antipsychotic medications. The patient participants in the intervention group also received LEAN (Lay health supporters, E-platform, Award, and iNtegration), a program that featured recruitment of a lay health supporter and text messages for medication reminders, health education, monitoring of early signs of relapses, and facilitated linkage to primary healthcare. The primary outcome was medication adherence (proportion of dosages taken) assessed by 2 unannounced home-based pill counts 30 days apart at the 6-month endpoint. The secondary and other outcomes included patient symptoms, functioning, relapses, re-hospitalizations, death for any reason, wandering away without notifying anyone, violence against others, damaging goods, and suicide. Intent-to-treat analysis was used. Missing data were handled with multiple imputations. In total, 271 out of 278 patient participants were successfully followed up for outcome assessment. Medication adherence was 0.48 in the control group and 0.61 in the intervention group (adjusted mean difference [AMD] 0.12 [95% CI 0.03 to 0.22]; p = 0.013; effect size 0.38). Among secondary and other outcomes we noted substantial reduction in the risk of relapse (26 [21.7%] of 120 interventional participants versus 40 [34.2%] of 117 controls; relative risk 0.63 [95% CI 0.42 to 0.97]; number needed to treat [NNT] 8.0) and re-hospitalization (9 [7.3%] of 123 interventional participants versus 25 [20.5%] of 122 controls; relative risk 0.36 [95% CI 0.17 to 0.73]; NNT 7.6). The program showed no statistical difference in all other outcomes. During the course of the program, 2 participants in the intervention group and 1 in the control group died. The limitations of the study include its lack of a full economic analysis, lack of individual tailoring of the text messages, the relatively short 6-month follow-up, and the generalizability constraint of the Chinese context. The addition of texting to patients and their lay health supporters in a resource-poor community setting was more effective than a free-medicine program alone in improving medication adherence and reducing relapses and re-hospitalizations. Future studies may test the effectiveness of customization of the texting to individual patients. Chinese Clinical Trial Registry ChiCTR-ICR-15006053.

Studies regarding blood pressure of Nepal have demonstrated a contrasting prevalence. We aimed at providing a generalized estimate of the prevalence of hypertension and prehypertension in urban, suburban, and rural areas of Nepal. This systematic review followed PRISMA guidelines. A thorough search of PubMed, EMBASE, and Web of Science was performed, and studies satisfying the eligibility criteria were reviewed. Pooled prevalence was calculated by random-effects model, and the sources of heterogeneity were explored with meta-regression and subgroup analysis. Twenty-three studies with 99,792 subjects were identified, and the estimated rate of hypertension and prehypertension were found to be 27.3% (95% CI: 23.8–30.9) and 35.4% (30.3–40.8). The prevalence of hypertension was 28.4% (22.4–34.7), 25.5% (21.4–29.8), and 24.4% (17.9–31.6) among urban, suburban, and rural populations, respectively. Moreover, rates of hypertension were found to be substantially higher in male (31.6%, 27.3–36.1) compared to female (20.0%, 14.2–26.6), and significantly higher among the middle-aged (≥40 years; 36.8%, 29.4–44.5) than among younger adults (< 40 years; 13.2%, 9.2–17.7). Further, prehypertension prevalence was found to be highest in rural areas (40.4%, 25.4–56.4) followed by urban areas (29.3%, 20.8–38.5) and lowest in suburban areas (25.5%, 18.9–32.7). Our study identified an alarming situation of hypertension among Nepalese males and middle-aged, and a situation of concern with prehypertension in rural areas affecting almost 40 % of the population.

Background: Public health workers at the Chinese Centre for Disease Control and Prevention (China CDC) and primary health care institutes (PHIs) were among the main workers who implemented prevention, control, and containment measures. However, their efforts and health status have not been well documented. We aimed to investigate the working conditions and health status of front line public health workers in China during the COVID-19 epidemic. Methods: Between 18 February and 1 March 2020, we conducted an online cross-sectional survey of 2,313 CDC workers and 4,004 PHI workers in five provinces across China experiencing different scales of COVID-19 epidemic. We surveyed all participants about their work conditions, roles, burdens, perceptions, mental health, and self-rated health using a self-constructed questionnaire and standardised measurements (i.e., Patient Health Questionnaire and General Anxiety Disorder scale). To examine the independent associations between working conditions and health outcomes, we used multivariate regression models controlling for potential confounders. Results: The prevalence of depression, anxiety, and poor self-rated health was 21.3, 19.0, and 9.8%, respectively, among public health workers (27.1, 20.6, and 15.0% among CDC workers and 17.5, 17.9, and 6.8% among PHI workers). The majority (71.6%) made immense efforts in both field and non-field work. Nearly 20.0% have worked all night for more than 3 days, and 45.3% had worked throughout the Chinese New Year holiday. Three risk factors and two protective factors were found to be independently associated with all three health outcomes in our final multivariate models: working all night for >3 days (multivariate odds ratio [ORm]=1.67~1.75, p<0.001), concerns about infection at work (ORm=1.46~1.89, p<0.001), perceived troubles at work (ORm=1.10~1.28, p 1 month at the current work intensity (ORm=0.44~0.55, p<0.001). Conclusions: Chinese public health workers made immense efforts and personal sacrifices to control the COVID-19 epidemic and faced the risk of mental health problems. Efforts are needed to improve the working conditions and health status of public health workers and thus maintain their morale and effectiveness during the fight against COVID-19.

We aimed to investigate the coping styles of Chinese pregnant women, identify factors associated with coping and further explore the effect of coping during pregnancy on postpartum depression. A longitudinal study was performed from early pregnancy to six-week postpartum. A total of 1126 women were recruited by convenience sampling and participants who completed eight questionnaires at four time points were included (three self-developed questionnaires, Coping Style Questionnaire, Generalized Anxiety Disorder-7, Brief Resilience Scale, Rosenberg Self-esteem Scale, Edinburgh Postnatal Depression Scale) (n = 615). Linear regression analyses were used to identify the possible factors for coping and their association with postpartum depression. The mean scores of positive coping and negative coping were 2.03 and 1.21, respectively. Women with a higher educational level scored higher on both positive and negative coping in pregnancy. Resilience was associated with both positive and negative coping, while self-esteem only related to positive coping (p < 0.05). Postpartum depression was associated with both positive and negative coping (p < 0.05). The women in our study reported using positive coping styles more than negative coping antenatally. Positive and negative coping behaviors could be used simultaneously. Increasing self-esteem and resilience antenatally might promote more positive coping and further reduce the occurrence of postpartum depression.

China recently issued a national plan on perinatal depression (PND) screening. Previous studies elsewhere suggested that uptake of referral after screening for PND is suboptimal, but little is known in China. In this cohort study including 1126 women in Hunan, we identified women at a high risk of PND using the Edinburgh Postpartum Depression Scale (EPDS) over multiple time points. We texted them and offered free consultations with a psychiatrist/psychologist. Among 248 screen-positive women, only three expressed interest and one attended the appointment. We surveyed the women about their reasons for declining referrals and preferred means of care. Of the 161 respondents, 128 (79.5%) indicated that they could cope with the condition without professional assistance and 142 (88.2%) chose their families as the preferred source of help. Only 15 (9.3%) chose professionals as their first option. Implementing a referral policy for screen-positive women would mean approximately one-third of women who gave birth in China would be eligible. Our result argues against referring all screen-positive women for professional services at this time. Interventions should instead build upon the tradition of family support in a more engaged response. These considerations are relevant for the implementation of national screening for PND in China.