Xinjin County Research Articles

Affiliate stigma and caregiving burden among family caregivers of persons with schizophrenia in rural China.

Although stigma and caregiving burden are important in relation to mental health recovery, few studies have been conducted on affiliate stigma and caregiving burden among family caregivers of persons with schizophrenia (FCPWS) in rural China. This study aimed to examine the severity level of affiliate stigma and caregiving burden, and identify the correlates among FCPWS in rural China. A mental health survey was conducted (N = 253 FCPWS) in Xinjin county, Sichuan province, China. Affiliate Self-Stigma Scale and Zarit Burden Interview Short Form were used. The regression analysis was performed to explore the correlates of stigma and burden. Most FCPWS reported experiencing high and severe level of affiliate stigma (78.66%) and caregiving burden (95.26%). Family caregivers who were middle aged, unemployed, with high caregiving burden and low quality of life (QoL), showed more severe affiliate stigma. Family caregivers who were female, older, with low income, high affiliate stigma and low QoL, experienced greater caregiving burden. The large majority of FCPWS in rural China experienced severe affiliate stigma, caregiving burden and poor QoL. It is crucial to develop culture-specific anti-stigma interventions to reduce caregivers' stigma and caregiving burden, and improve QoL. Specific risk factors of family caregivers' affiliate stigma and caregiving burden should be considered for development of health policy and community-based mental health services.

Planning of ecologically suitable areas for Ligusticum chuanxiong under background of soil cadmium pollution

Chuanxiong Rhizoma is a traditional Chinese medicinal material mainly produced in Sichuan and Chongqing of China. In recent years, the cadmium content in Chuanxiong Rhizoma produced in most of the genuine producing areas has exceeded the standard, which makes Chuanxiong Rhizoma difficult to be exported. To solve the problem of excessive cadmium content in soil, this study employed the MaxEnt model to simulate the potential geographic distribution of Ligusticum chuanxiong and evaluate important environmental factors, and re-plan its ecologically suitable areas based on the mineral distribution characteristics and soil cadmium pollution status. The results showed that the places suitable for L. chuanxiong growing covered an area of 335 523.69 km~2, mainly in central and eastern Sichuan, southern Shaanxi and most parts of Chongqing. Among them, the highly suitable areas of L. chuanxiong were mainly concentrated in Chengdu, Ya'an, Deyang, and Mianyang. Solar radiation, annual precipitation, and annual range of temperature were evaluated as important variables affecting the distribution of L. chuanxiong, with the contribution rates of 62.3%, 13.3%, and 6.8%, respectively. In addition, Qionglai county, Chongqing county, Mianyang city(Youxian district and Fucheng district), Qingchuan county, and Xinjin county were classified into the first-class ecologically suitable zone, covering a total area of 2 768.87 km~2. The se-cond-class ecologically suitable zone was even wider, involving such counties as Tongjiang county, Renshou county, Jianyang county, and Nanjiang county, and the total area reached 43 616.92 km~2. The re-planning of the ecologically suitable areas for L. chuanxiong has provided strong data support for the cultivation and resource development of L. chuanxiong and also new ideas for solving the problem of excessive cadmium content in L. chuanxiong.

Poverty transitions in severe mental illness: longitudinal analysis of social drift in China, 1994-2015.

Although poverty associated with severe mental illness (SMI) has been documented in many studies, little long-term evidence of social drift exists. This study aimed to unravel the poverty transitions among persons with SMI in a fast change community in China. Two mental health surveys, using the International Classification of Disease (ICD-10), were conducted in the same six townships of Xinjin county, Chengdu, China in 1994 and 2015. A total of 308 persons with SMI identified in 1994 were followed up in 2015. The profiles of poverty transitions were identified and regression modelling methods were applied to determine the predictive factors of poverty transitions. The poverty rate of persons with SMI increased from 39.9% to 49.4% in 1994 and 2015. A larger proportion of them had fallen into poverty (27.3%) rather than moved out of it (17.8%). Those persons with SMI who had lost work ability, had physical illness and more severe mental disabilities in 1994, as well as those who had experienced negative changes on these factors were more likely to live in persistent poverty or fall into poverty. Higher education level and medical treatment were major protective factors of falling into poverty. This study shows long-term evidence on the social drift of persons with SMI during the period of rapid social development in China. Further targeted poverty alleviation interventions should be crucial for improving treatment and mental recovery and alleviating poverty related to SMI.

Mortality and suicide in schizophrenia: 21-year follow-up in rural China.

Little is known about the trend and predictors of 21-year mortality and suicide patterns in persons with schizophrenia. To explore the trend and predictors of 21-year mortality and suicide in persons with schizophrenia in rural China. This longitudinal follow-up study included 510 persons with schizophrenia who were identified in a mental health survey of individuals (≥15 years old) in 1994 in six townships of Xinjin County, Chengdu, China, and followed up in three waves until 2015. Kaplan-Meier survival analysis and Cox hazard regressions were conducted. Of the 510 participants, 196 died (38.4% mortality) between 1994 and 2015; 13.8% of the deaths (n = 27) were due to suicide. Life expectancy was lower for men than for women (50.6 v. 58.5 years). Males consistently showed higher rates of mortality and suicide than females. Older participants had higher mortality (hazard ratio HR = 1.03, 95% CI 1.01-1.05) but lower suicide rates (HR = 0.95, 95% CI 0.93-0.98) than their younger counterparts. Poor family attitudes were associated with all-cause mortality and death due to other causes; no previous hospital admission and a history of suicide attempts independently predicted death by suicide. Our findings suggest there is a high mortality and suicide rate in persons with schizophrenia in rural China, with different predictive factors for mortality and suicide. It is important to develop culture-specific, demographically tailored and community-based mental healthcare and to strengthen family intervention to improve the long-term outcome of persons with schizophrenia.

Household poverty in people with severe mental illness in rural China: 1994-2015.

Little is known about poverty trends in people with severe mental illness (SMI) over a long time span, especially under conditions of fast socioeconomic development. This study aims to unravel changes in household poverty levels among people with SMI in a fast-changing rural community in China. Two mental health surveys, using ICD-10, were conducted in the same six townships of Xinjin county, Chengdu, China. A total of 711 and 1042 people with SMI identified in 1994 and 2015, respectively, participated in the study. The Foster-Greer-Thorbecke poverty index was adopted to measure the changes in household poverty. These changes were decomposed into effects of growth and equity using a static decomposition method. Factors associated with household poverty in 1994 and 2015 were examined and compared by regression analyses. The proportion of poor households, as measured by the headcount ratio, increased significantly from 29.8% in 1994 to 39.5% in 2015. Decomposition showed that poverty in households containing people with SMI had worsened because of a redistribution effect. Factors associated with household poverty had also changed during the study period. The patient's age, ability to work and family size were of paramount significance in 2015. This study shows that the levels of poverty faced by households containing people with SMI has become more pressing with China's fast socioeconomic development. It calls for further integration of mental health recovery and targeted antipoverty interventions for people with SMI as a development priority.

Change of poverty and outcome of persons with severe mental illness in rural China, 1994-2015.

It is unknown whether and how poverty influences the long-term outcome of persons with severe mental illness (SMI). To explore the change of poverty status in persons with SMI from 1994 to 2015 and examine the impact of poverty status on patients' outcome in rural China. Two mental health surveys using identical methods and International Classification of Disease (ICD-10) were conducted in 1994 and 2015 in the same six townships of Xinjin County, Chengdu, China. The annual net income per person was 19.8% and 100.2% higher for the general population than for persons with SMI in 1994 and 2015 respectively. Compared with 1994 (48.2%), persons with SMI in 2015 had significantly higher rates of poor family economic status (<mean) (65.2%) (p < .001). Persons with SMI in poor family economic status were significantly more likely to be male, unmarried, unable to work, with no family caregivers or a smaller number of family members, and in poor mental status in 1994 and 2015 (p < .05). The risk factors significantly associated with patients' poor mental status included poor work ability, younger age of first onset, never-treated status and poor family economic status. Relative poverty of persons with SMI has become more severe during the rapid socioeconomic development in rural China. Relative poverty of household, poor work ability, younger age of onset and never-treated status are risk factors of poor outcome. Culture-specific, community-based interventions and targeted poverty alleviation programs should improve patients' early identification, treatment and recovery.

Schizophrenia, social support, caregiving burden and household poverty in rural China.

Household poverty associated with schizophrenia has been long described. However, the mechanisms by which schizophrenia may have influenced the economic status of a household in rural communities are still unclear. This study aimed to test an integrated model of schizophrenia, social support and caregiving burden on household poverty in a rural community in China. A mental health survey using identical methods and ICD-10 was conducted in six townships of Xinjin County (population ≥ 15years old, n = 152,776), Chengdu, China in 2015. Identified persons with schizophrenia (n = 661) and their caregivers completed a joint questionnaire of sociodemographic information, illness conditions, social support and caregiving burden. Descriptive analysis was applied first to give an overview of the dataset. Then, multivariable regression analyses were conducted to examine the associative factors of social support, caregiving burden and household income. Then, structural equation modeling (SEM) was used to estimate the integrated model of schizophrenia, social support, caregiving burden and household income. Households with patient being female, married, able to work and having better social function were better off. Larger household size, higher social support and lower caregiving burden also had salient association with higher household income. The relationship between schizophrenia and household poverty appeared to be mediated by the impacts of schizophrenia on social support and caregiving burden. There was a strong association between schizophrenia and household poverty, in which social support and caregiving burden may had played significant roles on mediating it. More precise poverty alleviation policies and interventions should focus on supporting recovery for persons with schizophrenia, as well as on increasing social support and on reducing family caregiving burden.

Changes of family structure and treatment status of people with severe mental illness in rural China: a comparative study from 1994 to 2015

BackgroundLittle is known about the relationship between changes of family structure for people with severe mental illness (SMI) and treatment status of SMI during a period of sustained rapid socioeconomic development. This study aimed to explore the relationship between changes of family structure and treatment status of people with SMI in a 21-year longitudinal study in a rural area of China. MethodsEpidemiological surveys of mental disorders were conducted in May, 1994, and October, 2015, in the same six townships (total population 170 174 in 2015) in Xinjin county, Chengdu, which is a representative middle-income rural county in southwest China. The six townships were randomly selected from all 12 townships of Xinjin county in 1994. The surveys consisted of two steps: (1) screening procedures for psychosis (face-to-face interviews with the head of each household together with key informant interviews), household by household; and (2) psychiatric interviews of people aged 15 years and older, to identify those with SMI (including schizophrenia, bipolar disorders, and major depressive disorder) according to the International Classification of Mental and Behavioural Disorders-10 (ICD-10) criteria. The two surveys were approved by the university human research ethics committees. FindingsThe number of people aged 15 years and older who were identified to have SMI was 711 and 1042 in 1994 and 2015, respectively. The mean number of family members was significantly lower in 2015 (3·0 [SD 1·5]) than in 1994 (3·4 [1·5], p<0·0001). Compared with people with SMI in 1994, those with SMI in 2015 had a significantly higher rate of living alone (13·7% vs 9·9%, p<0·013) and without caregivers (15·6% vs 8·4%, p<0·0001). There was a significantly lower rate of parents as caregivers in 2015 than in 1994 (13·5% vs 17·9%, p<0·011). The rate of low family economic status (less than the population mean) for people with SMI was significantly higher in 2015 than in 1994 (p<0·0001). Fewer family members (included in the same family hukou) was significantly associated with low family economic status (p=0·023), and low family economic status was significantly associated with poor treatment status (p=0·015). InterpretationThe family structure and status of people with SMI has changed markedly during the rapid socioeconomic development from 1994 to 2015 in rural China. Fewer family members, fewer family caregivers and relative poverty have gradually become major challenges for families who care for people with SMI. How to improve care for people with SMI should be important if targets for Healthy China 2030 are to be met. Community mental health care, the precise poverty alleviation strategy, and the culture-specific family intervention programme should be crucial for comprehensive community mental health care and for improvement of the treatment and recovery of people with SMI in the community. FundingThe survey in 1994 was supported in part by the China Medical Board of New York (92-557). The survey in 2015 was supported in part by the Seed Funding Programme for Basic Research (2014–2016), Seed Funding Programme for Applied Research (2014–2016), Contemporary China Strategic Research Theme (2014–2016), Small Project Funding (2014–2016), and Mental Health Research in Chengdu, China (department matching fund, 2015–2017).

Treatment Status of Elderly Patients With Severe Mental Disorders in Rural China.

This study was performed to compare the treatment status between older (≥65 years) and younger adults (18-64 years) with severe mental illness (SMI) and explore factors associated with treatment status in rural China. Persons with SMI were identified in one mental health survey in 2015 in 6 townships of Xinjin County, Chengdu, China. Logistic regressions were conducted to explore factors associated with treatment status. Older adults with SMI, especially major depressive disorder, reported significantly lower rates of treatment than younger group. Older age, longer duration of illness, and poor mental status were risk factors for never-treated status in these patients. Never-treated status (46.3%) and poor treatment status in these older patients are serious issues. Different treatment statuses in these patients had various influencing factors. It is crucial to develop culture-specific, community-based mental health services to improve early identification, diagnosis, treatment, and recovery of older adults with SMI in rural China.

Perception of social support and psychotic symptoms among persons with schizophrenia: A strategy to lessen caregiver burden.

Improving patients' perception of social support is significant not only for their re-adaptation to life but also for alleviating caregivers' burden. This study aims to examine an integrated model regarding social support, psychotic symptoms and caregiver burden. Persons with schizophrenia (N1 = 300) and their family caregivers (N2 = 300) in Xinjin County, Chengdu, China, completed the survey to report their demographics, patients' perception of social support (Duke Social Support Index), psychotic symptoms (Positive and Negative Syndrome Scale) and caregiver burden (Burden Scale for Family Caregivers, Short Version). Structural equation modelling was utilised to test the proposed model. The degree of caregiver burden differed significantly within subgroups of patients' gender and education, as well as caregivers' gender, education and employment. Caregiver burden was negatively related to patients' age and household income. Social interaction partially mediated the relationship between instrumental and subjective social support (total effect = 0.451, p < .01). Subjective social support fully mediated the impact of social interaction on psychotic symptoms (total effect = -0.099, p < .05). In the final model, instrumental social support was positively associated with social interaction (p < .001) and increased subjective social support (p < .05). Increased subjective social support showed correlation with a lower degree of psychotic symptoms (p < .01), which was related to a lower level of caregiver burden (p < .001). This study shows the associations of patients' social support with psychotic symptoms and caregiver burden. Culture-specific psychosocial interventions should be provided for both patients and caregivers to enrich external support and reduce psychotic symptoms and caregivers' burden within the health care environment.

Changes in treatment status of patients with severe mental illness in rural China, 1994-2015.

Although it is crucial to improve the treatment status of people with severe mental illness (SMI), it is still unknown whether and how socioeconomic development influences their treatment status.AimsTo explore the change in treatment status in people with SMI from 1994 to 2015 in rural China and to examine the factors influencing treatment status in those with SMI. Two mental health surveys using identical methods and ICD-10 were conducted in 1994 and 2015 (population ≥15 years old, n = 152 776) in the same six townships of Xinjin County, Chengdu, China. Compared with 1994, individuals with SMI in 2015 had significantly higher rates of poor family economic status, fewer family caregivers, longer duration of illness, later age at first onset and poor mental status. Participants in 2015 had significantly higher rates of never being treated, taking antipsychotic drugs and ever being admitted to hospital, and lower rates of using traditional Chinese medicine or being treated by traditional/spiritual healers. The factors strongly associated with never being treated included worse mental status (symptoms/social functioning), older age, having no family caregivers and poor family economic status. Socioeconomic development influences the treatment status of people with SMI in contemporary rural China. Relative poverty, having no family caregivers and older age are important factors associated with a worse treatment status. Culture-specific, community-based interventions and targeted poverty-alleviation programmes should be developed to improve the early identification, treatment and recovery of individuals with SMI in rural China.Declaration of interestNone.

林分密度对新津文峰山马尾松人工林林下物种多样性和生物量的影响

林分密度对新津文峰山马尾松人工林林下物种多样性和生物量的影响

Poverty and outcomes of people with severe mental disorders in rural China: a 21-year survey

BackgroundLittle is known about the relationship between poverty and outcomes of severe mental illness (SMI) during a period of sustained rapid socioeconomic development. This study explored the relationship between poverty and outcomes of people with SMI in a 21-year longitudinal study in a rural area of China. MethodsEpidemiological surveys of mental disorders were conducted in May, 1994, and October, 2015, in the same six townships (total population 170 174 in 2015) in Xinjin County, Chengdu, China. Psychoses Screening Schedule together with key informant method for household survey and general psychiatric interview were administered to identify people with SMI (including schizophrenia, bipolar disorders, and major depressive disorder) according to International Classification of Mental and Behavioural Disorders-10 criteria. FindingsWe identified 711 people with SMI aged 15 years and older in 1994 and 1042 in 2015. The annual net income per person in people with SMI was significantly lower in 1994 (1110·0 RMB) and 2015 (8420·1 RMB) (p<0·0001) than in the population of Xinjin (1330·0 RMB and 16856·0 RMB, respectively). The rate of having poor family economic status (<mean level) in people with SMI was significantly higher in 2015 (65·2%) than in 1994 (48·2%, p<0·0001). Poor family economic status was significantly associated with being male and unmarried, a lower number of family members, and lower rates of partial and full remission of SMI in 1994 and 2015 (p<0·05). Poor family economic status was also significantly associated with lower education level, lower rate of having a family caregiver, higher total score on the Positive and Negative Syndrome Scale, lower total score of Global Assessment of Functioning, and lower rates of medication in 2015 (p<0·05). InterpretationRelative poverty has become more severe in people with SMI during the period of rapid socioeconomic development from 1994 to 2015 in China, and it is associated with poor outcomes of SMI. Prevention of the cycle of poverty and mental illness should be vital for Healthy China 2030. Targeted poverty alleviation programmes and community-based mental health care should be crucial for enhancing economic status and improving outcomes of people with SMI. FundingThe survey in 1994 was supported in part by China Medical Board of New York (92-557, principal investigator: MZX). The survey in 2015 was supported in part by Seed Funding Programme for Basic Research (Hong Kong University, 2014–2016, principal investigator: MSR), Seed Funding Programme for Applied Research (HKU, 2014–2016, principal investigator: MSR), Strategic Research Theme: Contemporary China Seed Funding (HKU, 2014–2016, principal investigator: MSR), Small Project Funding (HKU, 2014-2016, principal investigator: CLWC), and Mental Health Research in Chengdu, China (Department Matching Fund, 2015–2017, principal investigator: MSR).

Severe mental disorders in rural China: a longitudinal survey

BackgroundLittle is known about the change in long-term prevalence of mental disorders during a period of sustained rapid socioeconomic development. Here we explore the prevalence change of severe mental disorders in a 21-year longitudinal study in a rural area of China. MethodsEpidemiological surveys of mental disorders were done in May, 1994, and October, 2015, in six townships (total population 170 174 in 2015) in Xinjin County, Chengdu, China. Psychoses Screening Schedule (PSS) together with key informant method for household survey and general psychiatric interview were administered to identify the persons with severe mental disorders according to International Classification of Mental and Behavioural Disorders-10 (ICD-10) criteria. FindingsAmong all persons aged 15 years and older, the age-standardised lifetime prevalence of all mental disorders increased 48·2% from 870·1 per 100 000 population (95% CI 811·3–928·9 per 100 000 population) in 1994 to 1289·4 per 100 000 population (1218·0–1360·8 per 100 000 population) in 2015. The age-standardised lifetime prevalence of schizophrenia was the highest among all mental disorders and remained relatively stable from 1994 (416·0 per 100 000 population) to 2015 (427·9 per 100 000 population). Between 1994 and 2015, the age-standardised lifetime prevalence increased for affective disorders (41%), alcohol dependence and alcoholism (373·8%), drug and substance abuse (1809%), and mental disorder plus cerebrovascular disease (214%), brain trauma (388%), and senile dementia (126%). Moreover, age-standardised lifetime prevalence was significantly higher in men (1465·5 per 100 000 population) than in women (1179·0 per 100 000) in 2015 (p<0·0001). InterpretationVarious mental disorders in people living in the rural community display different trends from 1994 to 2015. Although the age-standardised lifetime prevalence of all causes disorders increased from 1994 to 2015, the prevalence of schizophrenia remained relatively stable. Prevalence of affective disorders, alcohol dependence and alcoholism, drug and substance abuse, senile dementia, and other organic disorders increased sharply, possibly indicating the effect of socioeconomic development on mental disorders. Mental health policy and services should be improved and adjusted according to the prevalence change of mental disorders. The limitations of this study include: (1) the sample investigated was from one rural area of China; (2) only two surveys were done; and (3) as many young people in this rural area might move to work temporarily in urban areas, the final reported prevalence might underestimate the true prevalence in young people. FundingThe investigation in 1994 was supported in part by the China Medical Board of New York (CMB, 92-557, to MZX). The investigation in 2015 was supported in part by Seed Funding Programme for Basic Research (HKU, 2014-2016, to MSR), Seed Funding Programme for Applied Research (HKU, 2014-2016, to MSR), Strategic Research Theme (SRT): Contemporary China Seed Funding (HKU, 2014-2016, to MSR), Small Project Funding (HKU, 2014-2016, to CLWC), and Mental Health Research in Chengdu, China (Dept. Matching Fund, 2015-2017, to MSR).

Family history of psychosis and outcome of people with schizophrenia in rural China: 14-year follow-up study.

This study examined the differences in 14-year outcomes of persons with schizophrenia with and without family history of psychosis in a rural community in China. All participants with schizophrenia (n=510) aged 15 years and older were identified in a 1994 epidemiological investigation of 123,572 people and followed up in 2004 and 2008 in Xinjin County, Chengdu, China. Individuals with positive family history of schizophrenia had significantly younger age of first onset than those with negative family history of schizophrenia in 1994 and 2004. Compared with individuals with negative family history of schizophrenia, those with positive family history of schizophrenia had significantly higher rate of homelessness and lower rate of death due to other reasons in 10-year (2004) and 14-year follow-up (2008). There were no significantly differences of mean scores on PANSS, SDSS and GAF in 2008 between positive and negative family history groups. The positive family history of schizophrenia is strongly related to younger age of onset, and may predict a poorer long-term outcome (e.g., higher rate of homelessness) in persons with schizophrenia in the rural community. The findings have implications for further studies on specific family-related mechanisms on clinical treatment and rehabilitation, as well as for planning and delivering of community-based mental health services.

First Report of Powdery Mildew Caused by Blumeria graminis on Avena sativa in China

Oat (Avena sativa) is extensively planted as a fodder crop and most of the production is used for livestock feed in China (Yang et al. 2010). In March 2017, powdery mildew was observed on A. sativa in the Forage Germplasm Nursery (30.47785° N, 103.75878° E) in Xinjin county, Sichuan Province, China. Approximately 40% of plants (about 0.2 ha in total) were affected. The symptoms initially appeared as irregular white mycelial colonies on the adaxial leaf surface. Subsequently, the colonies increased in numbers and size, later covered a large area of leaf and stem. In advance stage of infection, white patches turned into sunken reddish-brown lesions on leaf surface and eventually caused leaf death. The hyphae were flexuous, septate, branched, and 2.6 to 7.6 μm (n = 20) wide. The well developed appressoria on the hyphae were observed with diameter between 3.2 and 6.3 μm (n = 10). Conidiophores were unbranched and cylindrical with swollen bases, measuring 6.3 to 13.2 × 23.4 to 67.5 μm (n = 20), and borne verti...

Design and tests of 21 km, 5 Gbps, 0.14 THz wireless communication system

A terahertz wireless communication system is designed. The 16QAM modulation scheme is used in baseband processing, and mixers are used for cascading frequency up and down-converting. Cascading power amplification technique is adopted with a solid-state power amplifier and a vacuum electronic device. Several watts power is emitted at 0.14 THz. An all solid-state receiver running in room temperature is used, whose equivalent noise temperature is 1100 K and receiving sensitivity is -57 dBm. A 21 km wireless communication testing is carried out between the Shuangliu district and the Xinjin county of Chengdu, by means of two Cassegrain antennas with 50 dBi gain each. A 5 Gbps single-channel transmission speed is measured with bit error rate below 10-6. For testing, two standard HD-SDI uncompressed video streams are successfully transmitted in real time simultaneously, with an effective speed of 1.485 Gbps for each one.

The family economic status and outcome of people with schizophrenia in Xinjin, Chengdu, China: 14-year follow-up study.

Little is known about whether family economic status might influence the long-term (e.g. over 10 years) outcome of persons with schizophrenia in the community. To examine the differences in outcome at 14-year follow-up of persons with schizophrenia from high versus low family economic status backgrounds in a Chinese rural area. A prospective 14-year follow-up study was conducted in six townships in Xinjin County, Chengdu, China. All participants with schizophrenia ( n = 510) were identified in an epidemiological investigation of 123,572 people aged 15 years and older and followed up from 1994 to 2008. Individuals from low family economic status (<mean) in 1994 had significantly higher rate of homelessness (9.9%) and lower rate of survival (63.8%) in 2008 than those from high family economic status (⩾mean; 3.2% and 76.6%, respectively). Individuals from low family economic status had significantly lower rates of marriage and complete remission, higher mean scores on Positive and Negative Syndrome Scale (PANSS) and lower mean score on Global Assessment of Functioning (GAF) than those from high family economic status in 2008. The predictors of low family economic status of individuals in 2008 encompassed the baseline low family economic status, poor families' attitude toward the patient, younger age, older age of first onset and longer duration of illness. Low family economic status is a predictive factor of poor long-term outcome of persons with schizophrenia in the rural community. Individuals' family economic status should be considered in making mental health policy and providing community-based mental health services.

Enabling Health Reform through Regional Health Information Exchange: A Model Study from China

Objective. To investigate and share the major challenges and experiences of building a regional health information exchange system in China in the context of health reform. Methods. This study used interviews, focus groups, a field study, and a literature review to collect insights and analyze data. The study examined Xinjin's approach to developing and implementing a health information exchange project, using exchange usage data for analysis. Results. Within three years and after spending approximately $2.4 million (15 million RMB), Xinjin County was able to build a complete, unified, and shared information system and many electronic health record components to integrate and manage health resources for 198 health institutions in its jurisdiction, thus becoming a model of regional health information exchange for facilitating health reform. Discussion. Costs, benefits, experiences, and lessons were discussed, and the unique characteristics of the Xinjin case and a comparison with US cases were analyzed. Conclusion. The Xinjin regional health information exchange system is different from most of the others due to its government-led, government-financed approach. Centralized and coordinated efforts played an important role in its operation. Regional health information exchange systems have been proven critical for meeting the global challenges of health reform.

Marriage and outcomes of people with schizophrenia in rural China: 14-year follow-up study

The influence of marriage on the long-term outcomes of schizophrenia is largely unknown. This study was to examine the impact of marriage on the 14-year outcomes and identify the correlates of marriage among persons with schizophrenia in rural community. All study participants with schizophrenia (n=510) were identified in 1994 in an epidemiological investigation of 123,572 people aged 15years and older and followed up in 2004 and 2008 in Xinjin County, Chengdu, China. The Patients Follow-up Schedule (PFS) was used in 2004 and 2008. The rate of follow-up in 2008 was 95.9%. Unmarried individuals in 1994 had higher rates of homelessness and suicide, and lower rate of survival in 2004 and 2008 than those married. In 14-year follow-up, unmarried individuals were more likely to be male, to have higher level of psychiatric symptoms and lower rate of full remission of illness, and to report lower level of work functioning, as well as with fewer family members and caregiver, and lower family economic status. The predictors of being married in 2008 included being married in 1994, shorter duration of illness, being female, and lower level of education. Being married is predictive of more favorable 14-year outcomes of persons with schizophrenia in the rural community. Given that marriage can be instrumental for enhancing family-based support and caregiving, as well as improving the community tenure of persons with schizophrenia, it is important to develop programs to enhance opportunity for persons with schizophrenia to get and stay married.