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Back to table of contents Previous article Next article CommentaryFull AccessMental Health Response to the COVID-19 Outbreak in ChinaJunying Zhou, M.D., Ph.D., Liu Liu, M.D., Pei Xue, M.D., Xiaorong Yang, B.N., Xiangdong Tang, M.D., Ph.D.Junying Zhou, M.D., Ph.D., Liu Liu, M.D., Pei Xue, M.D., Xiaorong Yang, B.N., Xiangdong Tang, M.D., Ph.D.Published Online:7 May 2020https://doi.org/10.1176/appi.ajp.2020.20030304AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Transmission of the 2019 novel coronavirus (COVID-19) (1) has now widely and rapidly spread around the world. On March 11, 2020, the World Health Organization announced that COVID-19 is a pandemic (2). The rapid transmission and mortality risk of the COVID-19 infection may increase the risk of mental health problems among healthy individuals in the general public and worsen preexisting psychiatric problems in psychiatric patients, although data are still being gathered. A constellation of difficult feelings and psychological distress, including panic, worries, and depression, could be triggered by the fear of possible infection, being quarantined at hospitals and home, social isolation, and even the shortage of protective gear.A number of mental health surveys associated with the COVID-19 outbreak are being conducted in different vulnerable populations, which include infected patients, medical staff, students, and the general population. Liu et al. have reported results from a multicenter survey conducted among 1,563 medical staff members and found that the prevalence of depression and anxiety was 51% and 45%, respectively (3). So far, data on the mental health repercussions of the COVID-19 pandemic in outpatient populations have not been available. Thus, we conducted a questionnaire survey, from February 25 to March 9, 2020, among outpatients who sought care in the Departments of Psychiatry, Neurology, and Sleep Medicine in West China Hospital of Sichuan University (Chengdu, China). A self-report questionnaire was completed by outpatients, who provided consent, via the WeChat-based survey program Questionnaire Star. A total of 2,065 out of 3,441 patients completed the survey, including 589 new patients and 1,476 existing patients. The prevalence rates of mental health problems related to the COVID-19 outbreak, including anxiety (defined as a total score ≥5 on the Generalized Anxiety Disorder 7-item scale), depression (defined as a total score ≥5 on the Patient Health Questionnaire 9-item scale), and insomnia (defined as a total score ≥8 on the Insomnia Severity Index), were 25.5%, 16.9%, and 26.2%, respectively. Furthermore, 20.9% of patients (N=300) with preexisting psychiatric disorders (N=1,434) reported a deterioration of their mental health condition related to the pandemic. In particular, transportation restrictions, isolation at home, and fear of cross-infection in hospitals have inevitably become major concerns and barriers to treatment for these patients during the outbreak. Our survey also showed that 24.5% of new patients, including those with anxiety (N=46), depression (N=37), insomnia (N=79), and psychosis (N=21), could not receive timely diagnoses and treatment. Similarly, 22.0% of existing patients with diagnosed mental disorders, including depression, bipolar disorders, and schizophrenia (N=315), could not receive routine psychiatric care because of suspended hospital visits. Consequently, 18.1% of patients (N=259) have self-reduced medication dosages, and 17.2% of patients (N=247) stopped taking their medication because they could not gain access to prescriptions from physicians during the outbreak. As the lifetime prevalence of mental disorders is 16.6% among adults in China (4), millions of psychiatric patients may face barriers to help seeking for timely management of their mental health condition. The long-term repercussions of the viral pandemic on the management of psychiatric patients warrant further investigation. Nonetheless, our data reiterate the importance of implementing appropriate mental health care measures in the face of the COVID-19 pandemic.In response to the COVID-19 outbreak, there have been ongoing measures and concerted efforts in China that emphasize the importance of dealing with the potentially concurrent mental health crisis. On January 26, 2020, the National Health Commission of China released principles for emergency psychological crisis intervention for the COVID-19 pandemic (5). Mental health hotlines were quickly established across China and provided the public with counseling and psychological services. The telephone and Internet have been widely used to deliver mental health care services, and social media platforms (e.g., WeChat, Weibo) have been used to share strategies, guidelines, and education programs for managing potential mental distress. In addition, a series of self-help handbooks for psychological care associated with COVID-19 have been published by the China Association for Mental Health, medical institutions, and universities.Furthermore, a number of hospitals in China have initiated telemedicine services for patients in need during the outbreak of COVID-19. On January 26, 2020, West China Hospital of Sichuan University, as one of the leading hospitals in China, opened a free online outpatient service involving more than 100 medical doctors across specialties. This online outpatient service was created mainly to provide prescriptions to existing patients and to offer consultation to new patients. Our hospital collaborated with commercial courier services to deliver medication to patients' homes at no cost. To date, thousands of patients have received health care provided by this online outpatient service. Interestingly, only 7.4% of patients with mental disorders (N=136) in our survey have sought online help for medical care. Thus, there is a need to promote online mental health care services across China to manage mental health problems during the pandemic.The long-term outcomes of the mental health interventions in both community and hospital settings need further evaluation to determine how we can ameliorate the negative effects of viral outbreaks in the general public, especially among vulnerable patients with mental health problems.Sleep Medicine Center (Zhou, Xue, Tang), Department of Anesthesiology, Translational Neuroscience Center (Liu), and Outpatient Department (Yang), West China Hospital, Sichuan University, Chengdu, China.Send correspondence to Dr. Zhou ([email protected]).The authors report no financial relationships with commercial interests.The authors thank the clinic nurses in the Departments of Psychiatry, Neurology, and Sleep Medicine, West China Hospital, Sichuan University.References1 Lu R, Zhao X, Li J, et al.: Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet 2020; 395:565–574Crossref, Medline, Google Scholar2 World Health Organization (WHO): WHO director-general's opening remarks at the media briefing on COVID-19: 11 March 2020 (https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020)Google Scholar3 Liu S, Yang L, Zhang C, et al.: Online mental health services in China during the COVID-19 outbreak. Lancet Psychiatry 2020; 7:e17–e18Crossref, Medline, Google Scholar4 Huang Y, Wang Y, Wang H, et al.: Prevalence of mental disorders in China: a cross-sectional epidemiological study. Lancet Psychiatry 2019; 6:211–224Crossref, Medline, Google Scholar5 National Health Commission of China: [Principles for emergency psychological crisis intervention for the new coronavirus pneumonia.] http://www.nhc.gov.cn/jkj/s3577/202001/6adc08b966594253b2b791be5c3b9467.shtml (Chinese)Google Scholar FiguresReferencesCited byDetailsCited byRelationship between depression and burnout among nurses in Intensive Care units at the late stage of COVID-19: a network analysis1 April 2024 | BMC Nursing, Vol. 23, No. 1Effects of Long COVID on Psycho-Physical Conditions in the Italian Population: A Statistical and Large Language Model Combined Description27 April 2024 | European Journal of Investigation in Health, Psychology and Education, Vol. 14, No. 5The efficacy of internet-delivered cognitive-behavioral therapy for posttraumatic stress disorder according to the mean age of patients: a systematic review and meta-analysis11 December 2023 | Psychology, Health & Medicine, Vol. 29, No. 4Descripción de un Programa de Telesalud Mental en el Marco de la Pandemia de COVID-19 en ColombiaRevista Colombiana de Psiquiatría, Vol. 53, No. 2Longitudinal trajectories of anxiety and depression in subjects with different mental disorders after one year in the COVID-19 pandemicPsychiatry Research, Vol. 334The Impact of the COVID-19 Pandemic on the Mental Health of Families16 April 2024Effect of anxiety and depression on self-reported adverse reactions to COVID-19 vaccine: a cross-sectional study in Shanghai, China3 March 2023 | BMC Public Health, Vol. 23, No. 1Evaluation of cognitive functions in a group of Egyptian recovered COVID-19 patients22 May 2023 | Middle East Current Psychiatry, Vol. 30, No. 1Trends in telemedicine utilization for mental illness during the COVID-19 pandemic: an analysis of a nationwide database in Korea24 October 2023 | BMC Psychiatry, Vol. 23, No. 1Investigating the dynamic relationship between stigma of fear, discrimination and employees performance among healthcare workers during Covid-19 pandemic31 July 2023 | Cognition, Technology & Work, Vol. 25, No. 4"I Can't See an End in Sight." 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Journal of Palliative MedicineVol. 3, No. 1 Innovations in End-of-Life CareTaking a Spiritual History Allows Clinicians to Understand Patients More FullyDr. Christina Puchalski and Anna L. RomerDr. Christina Puchalski and Anna L. 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April 2020 | Cognitive, Affective, & Behavioral Neuroscience, Vol. 20, No. 3Patterns of Religiosity, Death Anxiety, and Hope in a Population of Community-Dwelling Palliative Care Patients in New Zealand—What Gives Hope If Religion Can’t?9 December 2019 | American Journal of Hospice and Palliative Medicine®, Vol. 37, No. 5Pain Management in Patients with Serious IllnessMedical Clinics of North America, Vol. 104, No. 3Varieties of Religious (Non)AffiliationJournal of Nervous & Mental Disease, Vol. 208, No. 5Cuidados paliativos31 August 2020 | PAJAR - Pan American Journal of Aging Research, Vol. 8, No. 1The Invisibility of Spiritual Nursing Care in Clinical Practice28 November 2019 | Journal of Holistic Nursing, Vol. 38, No. 1Spirituality in heart failure: a review of the literature from 2014 to 2019 to identify spiritual care needs and spiritual interventionsCurrent Opinion in Supportive & Palliative Care, Vol. 14, No. 1Plädoyer für einen (berufs-) alltagstauglichen Begriff von 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The Influence of Mentee Professional Identity on Mentoring Dynamics and Personal Learning Outcomes18 April 2019 | Group & Organization Management, Vol. 44, No. 2Teenagers and Cannabis Use: Why It's a Problem and What Can Be Done About ItJournal of Psychosocial Nursing and Mental Health Services, Vol. 57, No. 3Haken und Ösen: Spiritualität in der klinischen PalliativversorgungWege zum Menschen, Vol. 71, No. 2Approaching Spirituality Using the Patient-Centered Clinical Method27 January 2018 | Journal of Religion and Health, Vol. 58, No. 1Medical Students’ (Dis)comfort with Assessing Religious and Spiritual Needs in a Standardized Patient Encounter10 October 2018 | Journal of Religion and Health, Vol. 58, No. 1Spirituality and Religiosity of Pharmacy Students1 February 2019 | American Journal of Pharmaceutical Education, Vol. 83, No. 1Interprofessional spiritual care in oncology: a literature review16 February 2019 | ESMO Open, Vol. 4, No. 1Physical, Psychological/Psychiatric, Social, and Spiritual Problems and Symptoms13 April 2019Spiritual Assessment in Healthcare: An Overview of Comprehensive, Sensitive Approaches to Spiritual Assessment for Use Within the Interdisciplinary Healthcare Team18 May 2019The Role of the Nurse in Providing Spiritual Care: A Case Study Approach to Exploring Specific Care Provision by Healthcare Workers in the Context of an Interdisciplinary Healthcare Team18 May 2019Teaching and Learning About Spirituality in Healthcare Practice Settings18 May 2019Religion and Spirituality Among Medical Students5 June 2019Spiritual Care: The Role of Health Care Chaplaincy4 September 2019End-of-life milieu of critically sick children admitted to a pediatric hospital: A comparative study of survivors versus nonsurvivorsIndian Journal of Palliative Care, Vol. 25, No. 4Incorporating and Teaching Spirituality into Medical Education: An Overview of the Field and Possible Educational Strategies4 September 2019Religion, Spirituality, and Stress6 March 2019Toward Comprehensive Medicine: Listening to Spiritual and Religious Needs of Patients26 April 2019 | Gerontology and Geriatric Medicine, Vol. 5Din ve Psikoloji Arasındaki Uçurum Gerçekten Ne Kadar Derin? 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No AccessHealth, Nutrition, and Population1 Feb 2013Better Health Systems for India's PoorFindings, Analysis, and OptionsAuthors/Editors: David H. Peters, Abdo S. Yazbeck, Rashmi R. Sharma, G. N. V. Ramana, Lant H. Pritchett, Adam WagstaffDavid H. Peters, Abdo S. Yazbeck, Rashmi R. Sharma, G. N. V. Ramana, Lant H. Pritchett, Adam Wagstaffhttps://doi.org/10.1596/0-8213-5029-3SectionsAboutPDF (1.3 MB) ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinked In Abstract:This report focuses on four areas of the health system in which reforms, and innovations would make the most difference to the future of the Indian health system: oversight, public health service delivery, ambulatory curative care, and inpatient care (together with health insurance). Part 1 of the report contains four chapters that discuss current conditions, and policy options. Part 2 presents the theory, and evidence to support the policy choices. The general reader may be most interested in the overview chapter, and in the highlights found at the beginning of each of the chapters in part 2. These highlights outline the empirical findings, and the main policy challenges discussed in the chapter. The report does not set out to prescribe detailed answers for India ' s future health system. It does however, have a goal: to support informed debate, and consensus building, and to help shape a health system that continually strives to be more effective, equitable, efficient, and accountable to the Indian people, and particularly to the poor. 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Perspectives20 May 2003Medical Professionalism in the New Millennium: A Physician Charter 15 Months LaterFREELinda Blank, Harry Kimball, MD, Walter McDonald, MD, and Jaime Merino, MD, for the ABIM Foundation, ACP Foundation, and European Federation of Internal Medicine (EFIM)*Linda BlankFrom ABIM Foundation and ACP Foundation, Philadelphia, Pennsylvania; and European Federation of Internal Medicine, Maastricht, the Netherlands., Harry Kimball, MDFrom ABIM Foundation and ACP Foundation, Philadelphia, Pennsylvania; and European Federation of Internal Medicine, Maastricht, the Netherlands., Walter McDonald, MDFrom ABIM Foundation and ACP Foundation, Philadelphia, Pennsylvania; and European Federation of Internal Medicine, Maastricht, the Netherlands., and Jaime Merino, MDFrom ABIM Foundation and ACP Foundation, Philadelphia, Pennsylvania; and European Federation of Internal Medicine, Maastricht, the Netherlands., for the ABIM Foundation, ACP Foundation, and European Federation of Internal Medicine (EFIM)*Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-138-10-200305200-00012 SectionsAboutVisual AbstractAbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail AbstractFor a list of members of these organizations, see the Appendix.As we mark the 15-month anniversary of the physician charter that was published simultaneously in Annals of Internal Medicine and The Lancet in 2002 (1, 2), the members of the Medical Professionalism Project are pleased by the level of interest and activity the charter has engendered. Several hundred U.S. and international newspapers cited the charter in related stories; more than 70 radio, television, and online interviews have been conducted with individual project members; over 65 000 reprints have been requested from around the world; and, collectively, the Annals, Medical Professionalism Project and European Federation of Internal Medicine (EFIM) Web sites have logged more than 70 000 related visits. In addition, this issue of Annals features a collection of provocative Letters about the charter. Building on this level of responsiveness, the ABIM (American Board of Internal Medicine) Foundation and the ACP (American College of Physicians) Foundation will sponsor phase II of the Project, planned as a 2-year initiative. Phase II will encompass reviewing the charter's initial impact and, within that context, explore the opportunity to define the health rights and responsibilities of patients, physicians, and society.Background and RationaleThe Medical Professionalism Project, jointly sponsored by the ABIM Foundation and the ACP Foundation, began in November 1999 as a collaborative effort designed to raise the concept of professionalism within the consciousness of internal medicine, both in the United States and Europe. The two foundations, in partnership with the European Federation of Internal Medicine, are well positioned to influence the ethical and professional standards of medicine and encourage the profession to reaffirm its civic commitment.Impetus for the Project stemmed from the following question: Why is raising awareness about the core values of medical professionalism important? As the pace of change in health care accelerated and the future of medical practice became increasingly uncertain, the ABIM and ACP Foundations and European Federation of Internal Medicine saw the need to convene this collaborative project because medical professionalism is universally endangered. Physician unionization, waning ability to self-regulate, medical errors, bioterrorism, compromised access and health care delivery, conflicts of interest precipitated by managed care and for-profit medicine, and the pharmaceutical industry's role in patient care and medical education reflect the range of issues that challenge the medical profession globally. At this crossroads, the medical profession urgently needs a united front to influence and inform the culture and context of both clinical practice and medical training. The charter's three fundamental principles and set of professional responsibilities are intended to encourage such dedication and debate (Table).Table. Charter on Medical Professionalism: Fundamental Principles and Professional Responsibilities PublicationsTo date, in addition to Annals of Internal Medicine and The Lancet, the charter has been published in the following journals: Clinical Medicine (formerly Journal of the Royal College of Physicians), European Journal of Internal Medicine, American Journal of Obstetrics and Gynecology, The American Journal of Surgery, Journal of the American College of Dentists, Annals of the Royal College of Physicians and Surgeons of Canada, Canadian Medical Association Journal, The Medical Journal of Australia, Bollettino Ordine Provinciale Medici Chirurghi e Odontoiatri-Milano, La Revue de Mdecine Interne, and La Radiologia Medica. The charter has been translated into Italian, French, Spanish, Portuguese, German, and Polish. The Health Ministry of Italy also published the charter and distributed it to every medical student and faculty member throughout the country. Translations into Dutch, Swedish, Japanese, and Turkish should lead to future publication in journals written in these languages.PresentationsSince the charter's publication, project members and others have collectively given more than 100 related presentations in a variety of formats: named lectures, grand rounds, medical school graduation addresses, plenary sessions at national and international meetings, workshops, and seminars. National meetings have included those of the Association of American Medical Colleges, ACP, American College of Obstetricians and Gynecologists, American Medical Association, Arnold P. Gold Foundation, Council of Medical Specialty Societies, Accreditation Council for Graduate Medical Education, American Board of Medical Specialties, American College of Surgeons, Association for Hospital Medical Education, and Federation of State Medical Boards. International meetings have included those of the Association for Medical Education in Europe and the European School of Internal Medicine; the European Federation of Internal Medicine Congresses in Edinburgh and Berlin; the International Society of Internal Medicine Congress in Kyoto; and the Association of Canadian Medical Colleges, Ottowa Conference, and Royal College of Physicians and Surgeons of Canada.EndorsementsTo date, the following 90 professional associations, colleges, societies, and certifying boards have endorsed the charter: Accreditation Council for Graduate Medical Education; American Academy of Allergy, Asthma & Immunology; American Academy of Dermatology; American Academy of Family Physicians; American Academy of Neurology; American Academy of Ophthalmology; American Academy of Orthopaedic Surgeons; American Academy of OtolaryngologyHead and Neck Surgery; American Academy of Pediatrics; American Academy of Physical Medicine and Rehabilitation; American Board of Medical Specialties; American Board of Allergy and Immunology; American Board of Anesthesiology; American Board of Colon and Rectal Surgery; American Board of Dermatology; American Board of Emergency Medicine; American Board of Family Practice; American Board of Internal Medicine; American Board of Medical Genetics; American Board of Neurological Surgery; American Board of Nuclear Medicine; American Board of Obstetrics and Gynecology; American Board of Ophthalmology; American Board of Orthopedic Surgery; American Board of Otolaryngology; American Board of Pathology; American Board of Pediatrics; American Board of Physical Medicine and Rehabilitation; American Board of Plastic Surgery; American Board of Preventive Medicine; American Board of Psychiatry and Neurology; American Board of Radiology; American Board of Surgery; American Board of Thoracic Surgery; American Board of Urology; ABIM Foundation; American College of Dentists; American College of Medical Genetics; American College of Obstetricians and Gynecologists; ACP; American College of Radiology; American College of Surgeons; ACP Foundation; American Psychiatric Association; American Society of Anesthesiologists; American Society of Clinical Pathologists; American Society of Plastic Surgeons; American Urological Association; Association of Academic Physiatrists; Association of Physicians of Ireland; Association of Physicians of Malta; Austrian Society of Internal Medicine; Belgian Society of Internal Medicine; College of Physicians and Surgeons of British Columbia; Council of Deans, Association of Canadian Medical Colleges; Council of Medical Specialty Societies; Czech Society of Internal Medicine; Danish Society of Internal Medicine; Estonian Society of Internal Medicine; European Federation of Internal Medicine; Federation of Royal Colleges of Physicians of United Kingdom; Federation of State Medical Boards; Finnish Society of Internal Medicine; French Society of Internal Medicine; German Society of Internal Medicine; Hellenic Society of Internal Medicine; Hungarian Society of Internal Medicine; Israeli Society of Internal Medicine; Italian Society of Internal Medicine; Latvian Society of Internal Medicine; Lithuanian Society of Internal Medicine; Luxembourg Society of Internal Medicine; Ministero della Salute; Netherlands Society of Internal Medicine; Polish Society of Internal Medicine; Portuguese Society of Internal Medicine; Royal Australasian College of Physicians and Surgeons; Royal College of Physicians of Edinburgh; Royal College of Physicians of Ireland; Royal College of Physicians of London; Royal College of Physicians and Surgeons of Canada; Slovak Society of Internal Medicine; Slovenian Society of Internal Medicine; Society of Neurological Surgeons; Society of Nuclear Medicine; Society of Thoracic Surgeons; Spanish Society of Internal Medicine; Swedish Society of Internal Medicine; Swiss Society of Internal Medicine; and Turkish Society of Internal Medicine. During the remainder of the year, additional endorsements will be sought from state medical societies, educational organizations, and other national and international medical associations.Future ActivitiesThe ABIM Foundation has launched a series of targeted activities to promote the charter: 1) an attractive charter publication for distribution at medical school and residency orientation, white coat ceremonies, and graduation; 2) a charter wall poster suitable for framing; 3) Putting the Charter into Practice [small seed grants for implementation were awarded to McGill University; New York University School of Medicine; University of California, San Francisco; University of Michigan Medical School; and University of Texas Medical Branch, Galveston]; 4) Medical Professionalism Project colloquia and conferences; 5) professionalism portfolios designed to promote self-reflection and use of self-assessment tools; 6) inclusion of the charter with each ABIM diplomate's Board certificate; 7) a proposed charter series in peer-reviewed journals; and 8) a proposed award recognition program. The past, present, and future activities stimulated by the charter are being chronicled and will be essential in determining its short- and long-term impact toward promoting and empowering an action agenda for the profession of medicine that is universal in scope and purpose.Appendix: Project MembersABIM Foundation: Troyen Brennan, MD, JD (Project Chair); Linda Blank (Project Staff); Jordan Cohen, MD; Harry Kimball, MD; and Neil Smelser, PhD.ACP Foundation: Robert Copeland, MD; Risa Lavizzo-Mourey, MD, MBA; and Walter McDonald, MD.European Federation of Internal Medicine: Gunilla Brenning, MD; Chris Davidson, MA, MB, FRCP; Philippe Jaeger, MB, MD; Alberto Malliani, MD; Hein Muller, MD, PhD; Daniel Sereni, MD; and Eugene Sutorius, JD.Special Consultants: Richard Cruess, MD; Sylvia Cruess, MD; and Jaime Merino, MD.References1. Medical professionalism in the new millennium: a physician charter. Ann Intern Med. 2002;136:243-6. [PMID: 11827500] LinkGoogle Scholar2. Medical professionalism in the new millennium: a physicians' charter. Lancet. 2002;359:520-2. [PMID: 11853819] CrossrefMedlineGoogle Scholar Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: From ABIM Foundation and ACP Foundation, Philadelphia, Pennsylvania; and European Federation of Internal Medicine, Maastricht, the Netherlands.Disclosures: None disclosed.Corresponding Author: Linda Blank, ABIM Foundation, 510 Walnut Street, Suite 1700, Philadelphia, PA 19106; e-mail, [email protected]org.Current Author Addresses: Ms. Blank and Dr. Kimball: ABIM Foundation, 510 Walnut Street, Suite 1700, Philadelphia, PA 19106.Dr. McDonald: ACP Foundation, 190 N. Independence Mall West, Philadelphia, PA 19106.Dr. Merino: Depart. Medicina y Psiquiatria, Universidad Miguel Hernandez, Campus de San Juan, Cta. 332 Alicante-Valencia Km. 87, 03550 San Juan de Alicante, Spain. 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June 2022 | Cyberpsychology, Behavior, and Social Networking, Vol. 25, No. learning Review of Education, Vol. May 2022 | Vol. 12, No. in the experiences and to and reflections the year of January 2022 | The Clinical Vol. 36, No. Psychological and Academic M. and May 2022 | Cyberpsychology, Behavior, and Social Networking, Vol. 25, No. of via videoconference on fatigue and Implications for the March 2022 | Healthcare Management Vol. No. Policy of Technology April 2022 | Education Sciences, Vol. 12, No. under A July 2021 | Journal of Family Vol. 44, No. Strategies During the COVID-19 Pandemic: Virtual Learning for Public Health and Cancer Health April 2022 | Frontiers in Public Health, Vol. during How a to online interaction and social April 2022 | Journal of Research on Vol. 16, No. a Roadmap for Technology in Social Training the of Social February 2022 | in Social Vol. No. Psychological for with Learning during the Pandemic: The Experiences of in the March 2022 | Journal of Mental Health Research in Vol. 15, No. to education and communication the and intensive community during the COVID-19 Vol. No. to education and communication the and intensive community during the COVID-19 Vol. No. and implementation of a virtual pain management programme to COVID-19: a September 2021 | British Journal of Vol. 16, No. Video Conference Fatigue of in the on Video Conference Social and April 2022 | International Journal of Environmental Research and Public Health, Vol. 19, No. of in during the COVID‐19 pandemic: the and of and challenges and the of mental health and in December 2021 | Journal of Research in Educational Vol. 22, No. New with COVID-19 and A Qualitative Study on Zoom Fatigue30 March 2022 | Vol. 19, No. distance une No. Social in Remote Social A for of When the Social of Interactions via Videoconferencing March 2022 | Frontiers in Psychology, Vol. the stress of and of Zoom December 2021 | Electronic Vol. 32, No. social as of A study under in Human Behavior, Vol. the of to an online in to February 2022 | Sciences Education, Vol. 15, No. changes in social during COVID pandemic in the United December 2021 | Vol. 29, No. in Journal of and Vol. 13, No. or How online February 2022 | PLOS Vol. No. in Zoom Fatigue B. and February 2022 | Cyberpsychology, Behavior, and Social Networking, Vol. 25, No. of on mental August 2021 | Vol. 19, No. 1Videoconference Fatigue: A February 2022 | International Journal of Environmental Research and Public Health, Vol. 19, No. 4The Use of Videoconferencing in Higher January and digital communication in Australian December 2021 | Journal of the International for Business, Vol. No. and in Industry August Zoom Learning February and in During Coronavirus January of Leadership on June Online Social a from a of February An Approach to Social During Online June Virtual Reality August in a Mediated July – und February Teaching as an for Vol. 22, No. Video During the COVID-19 Pandemic and Effects on May 2021 | and Vol. No. During Remote Teaching in through a pandemic: impact of on and of Clinical Medicine, Vol. 18, No. during the pandemic A Systematic Review using April 2022 | Information Science, Vol. 6, No. Hybrid Learning Challenges and February de de de December 2022 | Vol. 4, No. of COVID‐19 with and variables in An analysis of September 2021 | The International Journal of Health and Management, Vol. 37, No. Design With Research for the Development of a Digital for and August 2022 | Journal of Research Vol. No. to Equity, and in Science and December 2021 | Frontiers in Science, Vol. December 2021 | Vol. 25, No. reality during the COVID-19 pandemic: A and and Vol. for study for a randomized controlled September 2021 | Pilot and Studies, Vol. 7, No. and A Design December in social of and mothers during the COVID-19 Vol. “Zoom A November 2021 | Applied Psychology, Vol. The from to of Human - and Psychology of the Pandemic November Through the October 2021 | Education, Vol. No. Practice During COVID-19 to and of November 2021 | Vol. 36, No. as the of Exploring and Perspectives of of Telehealth by a Australian Service during COVID-19 October 2021 | International Journal of Environmental Research and Public Health, Vol. 18, No. with The of technology and consumer July 2021 | International Journal of Consumer Studies, Vol. 45, No. of June 2021 | Annals of Surgery, Vol. No. and of Virtual in Video and Effects on of the ACM on Human-Computer Interaction, Vol. 5, No. How a Virtual Network during the COVID-19 of the ACM on Human-Computer Interaction, Vol. 5, No. May 2021 | American Journal of Clinical Vol. No. to and Education in the of December 2021 | Journal of Education, Vol. No. between social communication and during the early of September 2021 | Journal of Social and Vol. No. September 2021 | Vol. 11, No. Bir September 2021 | Vol. 5, No. of During the COVID-19 Pandemic by the of Medical of A Survey September 2021 | Frontiers in Medicine, Vol. student under remote learning using digital A June 2021 | Education and Information Vol. No. of the COVID-19 Pandemic on Higher Education: the

Journal of Women's HealthVol. 29, No. 4 CommentaryFree AccessSex and Gender Disparities in the COVID-19 PandemicJewel Gausman and Ana LangerJewel GausmanWomen & Health Initiative, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.Search for more papers by this author and Ana LangerAddress correspondence to: Ana Langer, MD, Women & Health Initiative, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 651 Huntington Avenue, FXB Building 6th Floor Office 643B, Boston, MA 02115 E-mail Address: [email protected]Women & Health Initiative, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.Search for more papers by this authorPublished Online:17 Apr 2020https://doi.org/10.1089/jwh.2020.8472AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookXLinked InRedditEmail In the case of the ongoing COVID-19 pandemic, sex-disaggregated data suggest that fewer women are dying from the disease than men.1 However, taking this observation at face value oversimplifies the biological, behavioral, and social and systemic factors that may cause differences to emerge with regard to how women and men experience both the disease and its consequences. As governments react with swift and severe measures in their ongoing fight to control the pandemic's spread, it is important to understand how these actions may disproportionately increase the risks for women both directly and indirectly with regard to sex and gender.Pregnant women are often among the most vulnerable groups during public health emergencies. In some cases, pregnant women face increased biological susceptibility to adverse health outcomes, as in the case of some respiratory infections. With other emergent coronaviruses, such as those responsible for severe acute respiratory syndrome (SARS) and middle east respiratory syndrome (MERS), pregnant women who became infected were found to be more likely than nonpregnant women to experience severe complications.2 It is still too early to tell whether this will be the case with COVID-19.In the ongoing pandemic, other factors may have a ripple effect that put women at increased risk even if the disease itself does not. As made clear during the 2014 Ebola outbreak, the consequences of large-scale infectious disease outbreaks on uninfected pregnant women can be dire. Routine prenatal care appointments, if not interrupted or discontinued, may put women at increased risk of exposure to the virus. Overwhelmed hospitals struggling to function with staff and supply shortages may not be able to provide the high quality of care that all pregnant women and their newborns deserve, let alone respond to emergency obstetric complications. Furthermore, there is also a risk that life-saving treatments or vaccines will be denied to pregnant women over concern for fetal safety or a lack of data.3,4The fear of infection, concern for the well-being of friends and loved ones, uncertainty, disruption, and social isolation that have become part and parcel of daily life for many around the world will undoubtedly have profound effects on mental health on the population at large, but being pregnant during a global pandemic is likely to be even more frightening for many women. Although containment strategies, such as those that require women to deliver without a companion present, including partners and doulas, that have already been put into place in some cities in the United States,5 or those that separate newborns from their mothers immediately after birth if the mother is infected with COVID-196 may be clinically important to reduce transmission, they may also have profound short- and long-term mental health implications for women. Among women who have young children, previous research in Ethiopia, India, and Vietnam found that women who experience family-related stressful life events, such as illness or death within the household and financial uncertainty, are more likely to experience episodes of severe mental distress.7 With the ongoing need to social distance, family and community networks may struggle and pregnant and postpartum women may feel even more vulnerable and isolated over a lack of social support.The adverse effects of the pandemic in relation to women's reproductive health are not limited to pregnancy or motherhood. As movement restrictions are put into place, supply chains are disrupted, and businesses are shuttered, some women may be at increased risk of unintended pregnancy should it become difficult to obtain their regular contraceptive method or emergency contraceptives, if needed. Furthermore, some states within the United States have begun to impose restrictions on certain medical procedures that they deem to be elective, including abortion, suggesting they must be delayed until after the pandemic is over.8 Spikes in domestic violence during times of crisis are another area of grave concern for women's health, and as governments continue to put into place more extreme measures to enforce social distancing, for some women, more time at home may mean more time spent with an abusive partner. Fewer social interactions may also mean less accountability for perpetrators and fewer opportunities for others to intervene.Gender-related factors may also increase the impact of the COVID-19 pandemic on women globally. Women constitute a disproportionately high percentage of caregivers in both the formal and informal sectors.9 A large proportion of frontline health care professionals (nurses, community health workers, health technicians, etc.) is women who face a higher risk of infection, morbidity, and death as a result of their profession.9 At the same time, women more frequently serve as the primary caregivers within a household, which may further increase their risk of exposure. In the United States, 65% of unpaid family caregivers are estimated to be women and 80% of them care for someone aged 50 years or older.10 Outside of their caregiving role, women are overrepresented in the informal employment sector. In low-and middle-income countries, two-thirds of women who work do so as part of the informal economy with limited access to health care for themselves and their families.9 Containment and mitigation policies that limit women's ability to perform their duties without offering effective alternatives, such as closing of daycare facilities for their children or not providing paid sick leave, may result in unnecessary exposure to disease and increased family vulnerability.It is urgent that we adopt a gender lens to study the pandemic and its effects, including the policies and actions that are put into place at the global, country, and local levels. This may be especially important in disadvantaged populations and resource-poor communities, where women are especially vulnerable. The public health community must ensure that existing health and social services meant to support women in the face of their unique needs do not disappear in lieu of the all-encompassing focus on stopping the pandemic. Furthermore, we argue that special attention needs to be paid to ensure that informal caregivers are supported, informed, and protected. To avoid making existing gender disparities larger as a result of the pandemic, a special body at the U.S. Centers of Disease Control and Prevention is urgently needed to track sex disaggregated data and analyze policies related to COVID-19 using a gender lens.Author Disclosure StatementNo competing financial interests exist.Funding InformationNo funding was received for this article.References1. Cai H. Sex difference and smoking predisposition in patients with COVID-19. Lancet Respir Med 2020;pii: S2213-2600(20)30117-X. Medline, Google Scholar2. Favre G, Pomar L, Musso D, Baud D. 2019-nCoV epidemic: What about pregnancies? Lancet 2020;395:e40. Crossref, Medline, Google Scholar3. Rasmussen SA, Smulian JC, Lednicky JA, Wen TS, Jamieson DJ. Coronavirus disease 2019 (COVID-19) and pregnancy: What obstetricians need to know. Am J Obstet Gynecol 2020;pii: S0002-9378(20)30197-6. Medline, Google Scholar4. Weigel G. Novel coronavirus "COVID-19": Special considerations for pregnant women. Available at: https://www.kff.org/womens-health-policy/issue-brief/novel-coronavirus-covid-19-special-considerations-for-pregnant-women/?utm_source=Global+Health+NOW+Main+List Accessed March 17, 2020. Google Scholar5. Caron C, Syckle KV. Laboring alone: Some hospitals bar partners because of virus fears. The New York Times. 2020. Google Scholar6. American College of Obstetricians and Gynecologists. Practice advisory: Novel coronavirus 2019 (COVID-19). Available at: https://www.acog.org/Clinical-Guidance-and-Publications/Practice-Advisories/Practice-Advisory-Novel-Coronavirus2019?IsMobileSet=false Accessed March 13, 2020. Google Scholar7. Gausman J, Austin SB, Subramanian S, Langer A. Adversity, social capital, and mental distress among mothers of small children: A cross-sectional study in three low and middle-income countries. PLoS One 2020;15:e0228435. Crossref, Medline, Google Scholar8. Tavernise S. Texas and Ohio include abortion as medical procedures that must be delayed. The New York Times. 2020. Google Scholar9. Langer A, Meleis A, Knaul FM, et al. Women and health: The key for sustainable development. Lancet 2015;386:1165–1210. Crossref, Medline, Google Scholar10. Feinberg L, Reinhard SC, Houser A, Choula R. Valuing the invaluable: 2011 update, the growing contributions and costs of family caregiving. Washington, DC: AARP Public Policy Institute, 2011:32. 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S. and May 2022 | Journal of Women's Health, Vol. 31, No. of women in clinical A for and Clinical Vol. and urban towards pandemic May 2022 | Vol. the The of during a January 2022 | & Psychology, Vol. 32, No. and During the and of the COVID-19 Pandemic in April 2022 | Frontiers in Vol. to Greater With the COVID-19 and to Journal of Health Psychology, Vol. 29, No. of to the of SARS-CoV-2 With Anxiety and A Study of March 2022 | International Journal of Public Health, Vol. in the Impact of COVID-19 Pandemic in in The Gender in Vol. No. 3Women's health and access COVID-19 Outlook, Vol. 70, No. of to COVID-19 Outcomes in a Longitudinal of February 2022 | Vol. No. as March 2022 | Saúde Vol. No. COVID-19 wave in during the of and its with higher February 2022 | PLOS ONE, Vol. 17, No. well-being and during the COVID-19 pandemic in the United A February 2022 | The Social Science Vol. to and February 2022 | Psychology, Vol. women's during the COVID-19 pandemic in June 2021 | and An International Vol. No. an and at the same in work and during the coronavirus April 2021 | International Journal of Psychology, Vol. No. and local A in the time of November 2021 | International Journal of Psychology, Vol. No. and the During June 2021 | & Vol. 26, No. of Medical Care among in the United States during the COVID-19 May 2022 | Journal of Public Health Research, Vol. 11, No. the Gender Disparities in COVID-19 and January 2022 | & Vol. with public health for COVID-19: a study of mothers with young children in the United February 2022 | Journal of in Vol. No. Perspectives on January and Among Adults During the to COVID-191 February in and and during the COVID-19 pandemic health and and Vol. in the COVID‐19 Effects of on December 2021 | British Journal of Vol. No. effects of the on for an emerging January 2022 | & Vol. No. Distress among Dental during the COVID-19 December 2021 | International Journal of Environmental Research and Public Health, Vol. 19, No. physical and social of health during the COVID-19 lockdown: a for of depression, and stress in the population during social isolation to the COVID-19 a cross-sectional study28 April 2021 | BMC Vol. No. and but same mortality of severe disease in March 2021 | BMC Medicine, Vol. No. Factors with and among community October 2021 | and Health, Vol. 17, No. differences in a of COVID-19 patients during the first and pandemic August 2021 | of Sex Vol. 12, No. in December 2021 | Journal of Clinical Medicine, Vol. 10, No. November 2021 | of Coronavirus Anxiety in Women on and Birth One of Coronavirus October 2021 | Journal of and Research, Vol. No. in and among Young Adults During Social to March 2021 | The Journal of Sex Research, Vol. No. of COVID-19 short- and long-term Disparities in and October 2021 | PLOS ONE, Vol. 16, No. analysis of on 2021 | Journal of in Medicine, Vol. No. of and Among COVID-19 by States in Women An September 2021 | and Vol. No. of COVID-19 using Public Gender and COVID-19: a Social Media of 2021 | Journal of Research, Vol. 5, No. for COVID-19 and its impact on in the Research on and Economics, Vol. No. differences in mental health of Canadian during the COVID-19 of and Health, Vol. No. Use and Relationship to Stress, and Perceived During the COVID-19 Pandemic in August 2021 | Frontiers in Public Health, Vol. and Lessons for August 2021 | PLOS ONE, Vol. 16, No. in How women in the United States in of of during the pandemic of March 2021 | Journal of Psychology, Vol. No. of in severe COVID-19 and Vol. No. the gender June 2021 | Journal of Perinatal Medicine, Vol. No. and the Related Factors in for COVID-19 at 2021 | International Journal of Health and Sciences, Vol. No. Gender Disparities and A Vol. No. impact of COVID‐19 on women to A of December | & Vol. No. of the and During the Covid-19 2021 | Frontiers in Psychology, Vol. in a January 2021 | Vol. No. responses to COVID-19 to Abuse & Vol. in and Practice During Social Among Young Adults in the May 2021 | Medicine, Vol. No. SARS-CoV-2 pandemic: A Health, Vol. and and after the pandemic April 2021 | Clinical and Research, Vol. No. on in August | Vol. 13, No. An to COVID-19 February 2022 | Journal of Women and Social Vol. No. in the and Outcomes of With May 2021 | Journal of Medicine, Vol. 16, No. of COVID-19: and May 2021 | Frontiers in Public Health, Vol. in the of February 2022 | Journal of Human Vol. No. and of the COVID-19 pandemic from the of in May 2021 | Journal of Social Work, Vol. No. the Pandemic: December April health disparities in vulnerable populations of psychiatric patients during the COVID-19 Journal of Vol. 11, No. 4The Gender of to in March 2021 | Feminist Economics, Vol. No. in Risk Factors and Mental Health During the of the COVID-19 Pandemic: A of U.S. Women A. E. E. and April 2021 | Journal of Women's Health, Vol. 30, No. and of and in March 2021 | Medicine, Vol. No. impact of COVID-19 on the mental health of and Science & Medicine, Vol. of and with in April 2021 | Vol. 12, No. health and well-being of staff during the coronavirus disease 2019 4 and in an March 2021 | Journal of Vol. of Gender in the and of Coronavirus Disease 2019 An of Health and and March 2021 | Journal of Women's Health, Vol. 30, No. of the COVID-19 pandemic on and Vol. of COVID-19 and of and Public Health, Vol. No. cross-sectional study of the of and with perceptions of to March 2021 | Open, Vol. 11, No. research and social of health: at the of of impact on and of Clinical Medicine, Vol. 17, No. differences in responses to SARS-CoV-2 in patients with January 2021 | Reports, Vol. No. and to COVID-19 in and January 2021 | Policy and Practice, Vol. impact of COVID-19 among and of November | & Health, Vol. 26, No. in case and mortality of coronavirus disease 2019 (COVID-19) among states in the United November | of Medicine, Vol. No. and pandemic risk and fear among September 2021 | Health and Behavioral Medicine, Vol. No. June 2021 | Vol. No. of and with of Coronavirus Related September 2021 | Vol. a January 2021 | Cadernos de Saúde Vol. No. and Among Vol. of Psychological Distress and Factors among During the COVID-19 Pandemic at in March 2021 | Disease and Vol. and on During the COVID-19 Pandemic in of Social Media October 2021 | Journal of Medical Research, Vol. 23, No. and and attitudes, and practices toward COVID-19 among birth of and Health Vol. 10, No. the of in COVID-19 October | Health Vol. No. in the of COVID-19 and political Vol. services in times of in of quality care for pregnant women and their October | Health Care for Women Vol. No. social support in the face of the December | Journal of & Vol. 12, No. with fear and during the COVID-19 pandemic in October | and Health, Vol. 16, No. and of People from by December | Journal of in Health, and Education, Vol. 10, No. is in gender and age for COVID-19 A December | Journal of and Vol. No. of SARS-CoV-2 Among Nursing and in September | Journal of Medicine, Vol. No. role of in the severity of learned from Vol. on gender disparities in the impact of the U.S. COVID-19 Research, Vol. Gender Women's Health and October | Frontiers in Global Women's Health, Vol. and the risk to and women during Journal of Vol. No. With Disparities in COVID-19 Outcomes in an Health Care October | JAMA Network Open, Vol. No. in the time of in August | Vol. 17, No. de la en en por September | Vol. No. de la COVID-19 en la de September | Vol. No. Perspectives to Health Research and Prevention During the COVID-19 | and Health Vol. 24, No. and Disease Disparities in the United in Vol. No. for a to | Global Public Health, Vol. No. and of in September | Vol. 11, No. and What is the Vol. No. we in Covid-19 women and men Vol. in of COVID-19: Insights a Vol. No. will The need to for the research on and the role of and and Vol. Impact and Factors During the of the Coronavirus (COVID-19) Pandemic Among the Population in June | Frontiers in Psychology, Vol. and of and the in SARS-CoV-2 to the in May | International Journal of Sciences, Vol. No. Coronavirus Disease 2019 the of August | Vol. Gender of to in January | Vol. Social of Vol. of of and Digital Vol. this Gausman and Ana and Gender Disparities in the COVID-19 of Women's in April 17,

Editorials21 September 2004Clinical Trial Registration: A Statement from the International Committee of Medical Journal EditorsFREECatherine De Angelis, MD, MPH, Jeffrey M. Drazen, MD, Frank A. Frizelle, MBChB, MMedSc, FRACS, Charlotte Haug, MD, PhD, MSc, John Hoey, MD, Richard Horton, FRCP, Sheldon Kotzin, MLS, Christine Laine, MD, MPH, Ana Marusic, MD, PhD, A. John P.M. Overbeke, MD, PhD, Torben V. Schroeder, MD, DMSc, Harold C. Sox, MD, and Martin B. Van Der Weyden, MDCatherine De Angelis, MD, MPH, Jeffrey M. Drazen, MD, Frank A. Frizelle, MBChB, MMedSc, FRACS, Charlotte Haug, MD, PhD, MSc, John Hoey, MD, Richard Horton, FRCP, Sheldon Kotzin, MLS, Christine Laine, MD, MPH, Ana Marusic, MD, PhD, A. John P.M. Overbeke, MD, PhD, Torben V. Schroeder, MD, DMSc, Harold C. Sox, MD, and Martin B. Van Der Weyden, MDAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-141-6-200409210-00109 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Altruism and trust lie at the heart of research on human subjects. Altruistic individuals volunteer for research because they trust that their participation will contribute to improved health for others and that researchers will minimize risks to participants. In return for the altruism and trust that make clinical research possible, the research enterprise has an obligation to conduct research ethically and to report it honestly. Honest reporting begins with revealing the existence of all clinical studies, even those that reflect unfavorably on a research sponsor's product.Unfortunately, selective reporting of trials does occur, and it distorts the body of evidence available for clinical decision making. Researchers (and journal editors) are generally most enthusiastic about the publication of trials that show either a large effect of a new treatment (positive trials) or equivalence of two approaches to treatment (noninferiority trials). Researchers (and journals) typically are less excited about trials that show that a new treatment is inferior to standard treatment (negative trials) and even less interested in trials that are neither clearly positive nor clearly negative, since inconclusive trials will not in themselves change practice. Irrespective of their scientific interest, trial results that place financial interests at risk are particularly likely to remain unpublished and hidden from public view. The interests of the sponsor or authors notwithstanding, anyone should be able to learn of any trial's existence and its important characteristics.The case against selective reporting is particularly compelling for research that tests interventions that could enter mainstream clinical practice. Rather than a single trial, it is usually a body of evidence, consisting of many studies, that changes medical practice. When research sponsors or investigators conceal the presence of selected trials, these studies cannot influence the thinking of patients, clinicians, other researchers, and experts who write practice guidelines or decide on insurance-coverage policy. If all trials are registered in a public repository at their inception, every trial's existence is part of the public record and the many stakeholders in clinical research can explore the full range of clinical evidence. We are far from this ideal at present, since trial registration is largely voluntary, registry data sets and public access to them vary, and registries contain only a small proportion of trials. In this editorial, published simultaneously in all member journals, the International Committee of Medical Journal Editors (ICMJE) proposes comprehensive trials registration as a solution to the problem of selective awareness and announces that all 11 ICMJE member journals will adopt a trials-registration policy to promote this goal.The ICMJE member journals will require, as a condition of consideration for publication, registration in a public trials registry. Trials must register at or before the onset of patient enrollment. This policy applies to any clinical trial starting enrollment after July 1, 2005. For trials that began enrollment prior to this date, the ICMJE member journals will require registration by September 13, 2005, before considering the trial for publication. We speak only for ourselves, but we encourage editors of other biomedical journals to adopt similar policies. For this purpose, the ICMJE defines a clinical trial as any research project that prospectively assigns human subjects to intervention or comparison groups to study the cause-and-effect relationship between a medical intervention and a health outcome. Studies designed for other purposes, such as to study pharmacokinetics or major toxicity (for example, phase I trials), would be exempt.The ICMJE does not advocate one particular registry, but its member journals will require authors to register their trial in a registry that meets several criteria. The registry must be accessible to the public at no charge. It must be open to all prospective registrants and managed by a not-for-profit organization. There must be a mechanism to ensure the validity of the registration data, and the registry should be electronically searchable. An acceptable registry must include at minimum the following information: a unique identifying number, a statement of the intervention (or interventions) and comparison (or comparisons) studied, a statement of the study hypothesis, definitions of the primary and secondary outcome measures, eligibility criteria, key trial dates (registration date, anticipated or actual start date, anticipated or actual date of last follow-up, planned or actual date of closure to data entry, and date trial data considered complete), target number of subjects, funding source, and contact information for the principal investigator. To our knowledge, at present, only www.clinicaltrials.gov, sponsored by the United States National Library of Medicine, meets these requirements; there may be other registries, now or in the future, that meet all these requirements.Registration is only part of the means to an end; that end is full transparency with respect to performance and reporting of clinical trials. Research sponsors may argue that public registration of clinical trials will result in unnecessary bureaucratic delays and destroy their competitive edge by allowing competitors full access to their research plans. We argue that enhanced public confidence in the research enterprise will compensate for the costs of full disclosure. Patients who volunteer to participate in clinical trials deserve to know that their contribution to improving human health will be available to inform health care decisions. The knowledge made possible by their collective altruism must be accessible to everyone. Required trial registration will advance this goal.Catherine De Angelis, MD, MPH, Editor-in-Chief, Journal of the American Medical AssociationJeffrey M. Drazen, MD, Editor-in-Chief, The New England Journal of MedicineProfessor Frank A. Frizelle, MBChB, MMedSc, FRACS, Editor, The New Zealand Medical JournalCharlotte Haug, MD, PhD, MSc, Editor-in-Chief, Norwegian Medical JournalJohn Hoey, MD, Editor, Canadian Medical Association JournalRichard Horton, FRCP, Editor, The LancetSheldon Kotzin, MLS, Executive Editor, MEDLINE; National Library of MedicineChristine Laine, MD, MPH, Senior Deputy Editor, Annals of Internal MedicineAna Marusic, MD, PhD, Editor, Croatian Medical JournalA. John P.M. Overbeke, MD, PhD, Executive Editor, Nederlands Tijdschrift voor Geneeskunde (Dutch Journal of Medicine)Torben V. Schroeder, MD, DMSc, Editor, Journal of the Danish Medical AssociationHarold C. Sox, MD, Editor, Annals of Internal MedicineMartin B. Van Der Weyden, MD, Editor, The Medical Journal of AustraliaCatherine De Angelis, MD, MPHEditor-in-Chief, Journal of the American Medical AssociationJeffrey M. Drazen, MDEditor-in-Chief, The New England Journal of MedicineProfessor Frank A. Frizelle, MBChB, MMedSc, FRACSEditor, The New Zealand Medical JournalCharlotte Haug, MD, PhD, MScEditor-in-Chief, Norwegian Medical JournalJohn Hoey, MDEditor, Canadian Medical Association JournalRichard Horton, FRCPEditor, The LancetSheldon Kotzin, MLSExecutive Editor, MEDLINE; National Library of MedicineChristine Laine, MD, MPHSenior Deputy Editor, Annals of Internal MedicineAna Marusic, MD, PhDEditor, Croatian Medical JournalA. John P.M. Overbeke, MD, PhDFrom Executive Editor, Nederlands Tijdschrift voor Geneeskunde.Torben V. Schroeder, MD, DMScEditor, Journal of the Danish Medical AssociationHarold C. Sox, MDEditor, Annals of Internal MedicineMartin B. Van Der Weyden, MDEditor, The Medical Journal of Australia Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: Catherine De Angelis, MD, MPH; Jeffrey M. Drazen, MD; Frank A. Frizelle, MBChB, MMedSc, FRACS; Charlotte Haug, MD, PhD, MSc; John Hoey, MD; Richard Horton, FRCP; Sheldon Kotzin, MLS; Christine Laine, MD, MPH; Ana Marusic, MD, PhD; A. John P.M. Overbeke, MD, PhD; Torben V. Schroeder, MD, DMSc; Harold C. Sox, MD; Martin B. Van Der Weyden, MDAffiliations: Corresponding Author: Customer Service, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoRegistration of Clinical Trials Alain Braillon , Gérard Dubois , and Michel Slama Registration of Clinical Trials Christine Laine and Harold C. Sox International Committee of Medical Journal Editors' Definition of a Clinical Trial Christine Laine Metrics Cited byHas the degree of outcome reporting bias in surgical randomized trials changed? A meta‐regression analysisReporting and transparent research practices in sports medicine and orthopaedic clinical trials: a meta-research studyClinical trial registration was associated with lower risk of bias compared with non-registered trials among trials included in systematic reviewsStrategies for using topical corticosteroids in children and adults with eczemaProspective trial registration and publication rates of randomized clinical trials in digital health: A cross-sectional analysis of global trial registriesReferencesClinical trial registry searches are under-utilized in systematic reviews from critical care journals: A bibliometric analysisSelective outcome reporting in root coverage randomized clinical trialsPatient Participation in Clinical Trials of Oncology Drugs and Biologics Preceding Approval by the US Food and Drug AdministrationUse of corticoids and non-steroidal anti-inflammatories in the treatment of rheumatoid arthritis: Systematic review and network meta-analysisPoor compliance of clinical trial registration among trials included in systematic reviews: a cohort studyPublication Rate and Consistency of Registered Trials of Motor-Based Stroke RehabilitationRegistering your research: What's required?Proportion of Patients in Phase I Oncology Trials Receiving Treatments That Are Ultimately ApprovedCharacteristics of studies of pharmacist services registered in ClinicalTrials.govFrom registration to publication: A study on Dutch academic randomized controlled trialsEthical and Policy Issues for Seamless Phase I Oncology TrialsForensic science needs registered reportsComparison of Clinical Trial Changes in Primary Outcome and Reported Intervention Effect Size Between Trial Registration and PublicationDialysate temperature reduction for intradialytic hypotension for people with chronic kidney disease requiring haemodialysisAmerican College of Physicians Ethics Manual Seventh EditionLois Snyder Sulmasy, JD and Thomas A. Bledsoe, MD, for the ACP Ethics, Professionalism and Human Rights Committee*A Risk-Based Paradigm of Biomarkers in Clinical TrialsInteresting TimesThe enforcement of mandatory disclosure rulesAn observational analysis of discontinuation and non-publication of osteoarthritis trialsDifferences between protocols for randomized controlled trials and systematic reviewsA mapping of 115,000 randomized trials revealed a mismatch between research effort and health needs in non–high-income regionsPublication of Randomized Clinical Trials in Pediatric ResearchOpen season: positive changes for increased transparency in the biomedical literatureKeeping a watchful eye on the food giants and cleansing the temple of nutritional medicine and epidemiologyThe Role and Importance of Clinical Trial Registries and Results DatabasesClinical trial registry use in anaesthesiology systematic reviewsData Escrow and Clinical Trial TransparencyHarlan M. Krumholz, MD, SM and Jeanie Kim, JDPublication Rates of Abstracts Presented at the Society of General Internal Medicine Annual MeetingPhase-II trials in osteosarcoma recurrences: A systematic review of past experienceOn Fishing for Significance and Statistician's Degree of Freedom in the Era of Big Molecular DataThe method of systematic review for clinical guidelinesA metadata schema for data objects in clinical researchRandomized trials in top dermatological journals, 2009-13Compliance with prospective trial registration guidance remained low in high-impact journals and has implications for primary end point reportingApplication of an automated natural language processing (NLP) workflow to enable federated search of external biomedical content in drug discovery and developmentCONSORT and clinical trial reporting: room for improvementDeveloping timely insights into comparative effectiveness research with a text-mining pipelineThe Changing Geography of Clinical Research: A Critical Analysis of Its DriversManaging the incidence of selective reporting bias: a survey of Cochrane review groupsConsiderations from the risk of bias perspective for updating Cochrane reviewsRegistration status and outcome reporting of trials published in core headache medicine journalsPeer reviewDo surgery journals insist on reporting by CONSORT and PRISMA? A follow-up survey of 'instructions to authors'Investigation of publication bias in meta-analyses of diagnostic test accuracy: a meta-epidemiological studyStandardization of Patient Outcomes Reporting in Percutaneous NephrolithotomyDesign and execution of clinical trials in orthopaedic surgeryMaking Prospective Registration of Observational Research a RealityReplication and the Manufacture of Scientific Inferences: A Formal ApproachElectromagnetic fields for treating osteoarthritisHow Psychiatry Journals Support the Unbiased Translation of Clinical Research. A Cross-Sectional Study of Editorial PoliciesIntegrated disease management interventions for patients with chronic obstructive pulmonary diseaseEuropean Union Clinical Trials Register: on the way to more transparency of clinical trial dataPRAISE (Prospective Randomized Amlodipine Survival Evaluation) and Criticism ∗What If We Were Texas Sharpshooters? Predictor Reporting Bias in Regression AnalysisLearning from failure - rationale and design for a study about discontinuation of randomized trials (DISCO study)Lack of proportionality. 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Schulz, PhD, MBA, Douglas G. Altman, DSc, and David Moher, PhD, for the CONSORT Group*Implementing registries and results databases of clinical trials: is there a side effect?Can Clinical Trial Results Databases and Manuscripts Coexist?ReferencesClinical Trial Overview and Enrollment«Conflict of Interest» oder Interesse am Konflikt? 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Survey of a Pubmed sampleReview of new regulations for the conduct of clinical trials of investigational medicinal productsRegistro dos ensaios clínicosPaliperidone: quo vadis?Guidelines for the conduct of clinical trials for spinal cord injury as developed by the ICCP panel: clinical trial designPeer review policies and theCanadian Journal of Anesthesia: an update for authors and readersReported Outcomes in Major Cardiovascular Clinical Trials Funded by For-Profit and Not-for-Profit Organizations: 2000–2005Clinical research design and reporting: always room for improvement!Quality assessment of randomized controlled trials in the treatment of hepatocellular carcinomaNew regulatory rules for clinical trials in the United States and the European Union: Key points and comparisonsThe Editor as umpire: clinical trial registration and dispute resolutionQuality of Trials in a Systematic Review of Powered Toothbrushes: Suggestions for Future Clinical TrialsThe need to register clinical trials in orthodonticsClinical trial data: to disclose or not to disclose?International Committee of Medical Journal Editors' Definition of a Clinical TrialChristine Laine, MD, MPH, Senior Deputy EditorIs This Clinical Trial Fully Registered? A Statement from the International Committee of Medical Journal Editors*Catherine D. De Angelis, MD, MPH, Jeffrey M. Drazen, MD, Frank A. Frizelle, MB, ChB, MMedSc, FRACS, Charlotte Haug, MD, PhD, MSc, John Hoey, MD, Richard Horton, FRCP, Sheldon Kotzin, MLS, Christine Laine, MD, MPH, Ana Marusic, MD, PhD, A. John P.M. Overbeke, MD, PhD, Torben V. Schroeder, MD, DMSc, Harold C. Sox, MD, and Martin B. Van Der Weyden, MDAnnals 2004–2005: A Peek Back and a Look ForwardThe EditorsRegistration of Clinical TrialsAlain Braillon, MD, Gérard Dubois, MD, and Michel Slama, MDRegistro (de ensayos clínicos) sin fronteras 21 September 2004Volume 141, Issue 6Page: 477-478KeywordsClinical trial reportingClinical trialsHealth careHeartInformation storage and retrievalLibrariesPharmacokineticsResearch ethicsToxicityTreatment guidelines ePublished: 21 September 2004 Issue Published: 21 September 2004 PDF downloadLoading ...

No AccessWorld Development Report1 Feb 2013World Development Report 1993Investing in Health, Volume1Authors/Editors: World BankWorld Bankhttps://doi.org/10.1596/0-1952-0890-0AboutView ChaptersPDF (6.2 MB) ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinked In Abstract:This is the sixteenth in the annual series and examines the interplay between human health, health policy and economic development. Because good health increases the economic productivity of individuals and the economic growth rate of countries, investing in health is one means of accelerating development. More important, good health is a goal in itself. During the past forty years life expectancy in the developing world has risen and child mortality has decreased, sometimes dramatically. But progress is only one side of the picture. The toll from childhood and tropical diseases remains high even as new problems - including AIDS and the diseases of aging populations - appear on the scene. And all countries are struggling with the problems of controlling health expenditures and making health care accessible to the broad population. This report examines the controversial questions surrounding health care and health policy. Its findings are based in large part on innovative research, including estimation of the global burden of disease and the cost-effectiveness of interventions. These assessments can help in setting priorities for health spending. The report advocates a threefold approach to health policy for governments in developing countries and in the formerly socialist countries. First, to foster an economic environment that will enable households to improve their own health. Policies for economic growth that ensure income gains for the poor are essential. So, too, is expanded investment in schooling, particulary for girls. Second, redirect government spending away from specialized care and toward such low-cost and highly effective activities such as immunization, programs to combat micronutrient deficiencies, and control and treatment of infectious diseases. By adopting the packages of public health measures and essential clinical care dsecribed in the report, developing countries could reduce their burden of disease by 25 percent. Third, encourage greater diversity and competition in the provision of health services by decentralizing government services, promoting competitive procurement practices, fostering greater involvement by nongovernmental and other private organizations, and regulating insurance markets. These reforms could translate into longer, healthier, and more productive lives for people around the world, and especially for the more than 1 billion poor. As in previous editions, this report includes the World Development Indicators, which give comprehensive, current data on social and economic development in more than 200 countries and territories. Previous bookNext book FiguresreferencesRecommendeddetailsCited byLatin America at the margins? 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The Journal of Alternative and Complementary MedicineVol. 26, No. 5 CommentariesPublic Health Approach of Ayurveda and Yoga for COVID-19 ProphylaxisGirish Tillu, Sarika Chaturvedi, Arvind Chopra, and Bhushan PatwardhanGirish TilluAYUSH Center of Excellence, Center for Complementary and Integrative Health, Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, India.Search for more papers by this author, Sarika ChaturvediDr. D.Y. Patil Vidyapeeth (DPU), Pune, India.Search for more papers by this author, Arvind ChopraCenter for Rheumatic Diseases, Pune, India.Search for more papers by this author, and Bhushan PatwardhanAddress correspondence to: Bhushan Patwardhan, AYUSH Center of Excellence, Center for Complementary and Integrative Health, Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, India E-mail Address: [email protected]AYUSH Center of Excellence, Center for Complementary and Integrative Health, Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, India.Search for more papers by this authorPublished Online:11 May 2020https://doi.org/10.1089/acm.2020.0129AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookXLinked InRedditEmail View articleFiguresReferencesRelatedDetailsCited byDNA metabarcoding uncovers fungal communities in Zingiberis RhizomaChinese Herbal Medicines, Vol. 6"We are adapting to it because it is within us": The co‐becoming of COVID‐19 in Malawi20 December 2023 | World Medical & Health Policy, Vol. 5COVID-19 Cases and Comorbidities: Complementary and Alternative Medicinal Systems (CAM) for Integrated Management of the PandemicJournal of Herbal Medicine, Vol. 42Traditional Formulations for Managing COVID-19: A Systematic Review Rudra B. 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Mills14 July 2020 | The Journal of Alternative and Complementary Medicine, Vol. 26, No. 7AYUSH for COVID-19 managementJournal of Ayurveda and Integrative Medicine, Vol. 11, No. 2Indians vs.COVID-19: The scenario of mental healthSensors International, Vol. 1Preventive strategies to combat infections–a review of traditional practices and Ayurveda concepts1 January 2020 | International Journal of Complementary and Alternative Medicine, Vol. 13, No. 3COVID-19: A new horizon for ayurvedaAYUHOM, Vol. 7, No. 2Ayurveda: The promising shelter for the mankind in the wake of COVID-19 pandemicJournal of Ayurveda Case Reports, Vol. 3, No. 1Epidemic containment measures in Unani medicine and their contemporary relevanceJournal of Indian System of Medicine, Vol. 8, No. 2COVID 19 in ayurvedic perspectiveInternational Journal of Health & Allied Sciences, Vol. 9, No. 5 Volume 26Issue 5May 2020 InformationCopyright 2020, Mary Ann Liebert, Inc., publishersTo cite this article:Girish Tillu, Sarika Chaturvedi, Arvind Chopra, and Bhushan Patwardhan.Public Health Approach of Ayurveda and Yoga for COVID-19 Prophylaxis.The Journal of Alternative and Complementary Medicine.May 2020.360-364.http://doi.org/10.1089/acm.2020.0129Published in Volume: 26 Issue 5: May 11, 2020Online Ahead of Print:April 20, 2020 TopicsCOVID-19Yoga PDF download

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This report summarizes the main activities conducted by the WPA in implementation of its Action Plan 2008–2011, approved by the General Assembly in September 2008 1,2. WPA Member Societies have participated in the WPA-World Health Organization (WHO) Global Survey of Psychiatrists’ Attitudes Towards Mental Disorders Classification, whose results have been published in World Psychiatry 3 and are expected to significantly influence the ICD revision process. Each Society has received a file with its own raw data and the results of the analysis of those data. Several Societies are producing papers based on those results. Many WPA officers or experts have been appointed as chairpersons or members of ICD-11 Working Groups. The chairpersons include W. Gaebel (Working Group on Psychotic Disorders), M. Maj (Working Group on Mood and Anxiety Disorders), P. Tyrer (Working Group on Personality Disorders), L. Salvador-Carulla (Working Group on Intellectual Disabilities), and O. Gureje (Working Group on Somatoform Disorders). The WPA President is a member of the ICD-11 International Advisory Board. World Psychiatry is one of the main channels through which the international psychiatric community is following the ICD-11 development. A special article authored by the ICD-11 International Advisory Board, summarizing the philosophy of the entire process, has been published in the journal 4. A report by the Working Group on Intellectual Disabilities appears in this issue 5. Several papers produced by the Working Group on Mood and Anxiety Disorders will be collected in a special supplement to the journal. Forums on various topics relevant to ICD-11 development have been published or are scheduled for publication in the journal (e.g., 6,7,8,9,10,11). Several WPA Member Societies and experts are being or will be involved in ICD-11 field trials and in the various translations/adaptations of the diagnostic system. The WPA is actively contributing to the process of harmonization between the ICD-11 and the DSM-5. The WPA contribution to the management of mental health consequences of major disasters has had, during the triennium, two components: a) training and sensitization of psychiatrists; b) intervention when a major disaster occurred. The first component has been implemented through a series of train-the-trainers workshops and sensitization courses. The train-the-trainers workshops aimed to train psychiatrists of the various regions of the world (with a special focus on those at highest risk) to address the mental health consequences of disasters, so that they can become them-selves trainers for other mental health professionals in their regions and represent a resource for their countries when a new disaster occurs. The first of these train-the-trainers workshops was co-organized with the WHO in Geneva in July 2009 12. Among the participants were psychiatrists who subsequently had a leading role in addressing the mental health consequences of disasters in their countries, including Y. Suzuki (who is currently coordinating mental health interventions in the prefecture of Sendai, Japan) and U. Niaz (who coordinated mental health efforts on the occasion of a recent disaster in Pakistan). Further train-the-trainers workshops have been held in Bangladesh, China, Russia, Egypt, Brazil and Argentina. The sensitization courses aimed to call the attention of psychiatrists worldwide to the mental health consequences of disasters and to update them about strategies of prevention and intervention. These courses have been held within all major WPA meetings in 2010 and 2011. The intervention component of the WPA strategy has been implemented in different ways, depending on the peculiarities of the various disasters. In 2010, on the occasion of the Haiti emergency, the WPA partnered with its Member Societies and relevant Scientific Sections and with the WHO in recruiting psychiatrists who were well trained, able to speak French and Creole, and willing to spend a prolonged period of time in the area of the emergency. A report by Dr. K. Ravenscroft, who was recruited through this mechanism and served for many months in Haiti, has been published in World Psychiatry 13. In 2011, on the occasion of the Japan emergency, the WPA has partnered with the Japanese Society of Psychiatry and Neurology in building up an intervention and research project focusing on the nuclear component of the disaster, which is going to be funded by the Japanese government. Dr. E. Bromet, a prominent international expert of mental health consequences of nuclear disasters, has acted as an advisor in the preparation of the project. Two papers related to this initiative have appeared in World Psychiatry 14,15. World Psychiatry, the WPA official journal, is the most widespread psychiatric journal in the world, reaching more than 33,000 psychiatrists in 121 countries, and being for many thousands of them the only accessible international psychiatric journal 16. The journal is published regularly in seven languages: English, Spanish, Chinese, Russian, French, Arabic and Turkish. Individual papers or abstracts are translated in further languages, including Japanese, Polish, Romanian and Italian, and posted on the WPA website (www.wpanet.org) and/or those of the relevant WPA Member Societies. The journal has now an impact factor of 5.562, ranking 9 out of 126 psychiatric journals. All issues of the journal can be freely downloaded from PubMed Central and the WPA website. The WPA has produced during the triennium four guidance papers on issues of great practical interest to psychiatrists worldwide, never covered in the past by international guidelines. Each guidance paper has been developed by an international task force, translated into several languages, posted on the WPA website and published in World Psychiatry. The papers deal with steps, obstacles and mistakes to avoid in the implementation of community mental health care 17; how to combat stigmatization of psychiatry and psychiatrists 18; mental health and mental health care in migrants 19; and protection and promotion of mental health in children of persons with severe mental disorders 20. The WPA has implemented during the triennium a programme of one-year research fellowships for early-career psychiatrists from low or lower-middle income countries, in collaboration with internationally recognized centers of excellence in psychiatry. These centers included the Department of Psychiatry and Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; the Institute of Psychiatry, King's College, London, UK; the University of Maryland School of Medicine, Baltimore, MD, USA; the Orygen Youth Health Research Centre, University of Melbourne, Australia; and the Mood Disorders Programme, Case Western Reserve School of Medicine, Cleveland, OH, USA. Six early-career psychiatrists (three from Asia, two from Africa and one from Latin America) have been selected on the basis of calls for applications posted on the WPA website. They have committed themselves to apply in their country of origin what they learn through this initiative. Interim or final reports by these fellows about their experience are available on the WPA website. The WPA has funded during the triennium several collaborative research projects, selected on the basis of international calls posted on the Association's website. These projects deal with the factors facilitating or hampering the choice of psychiatry as a career by medical students; stigmatization of psychiatry and psychiatrists; depression, demoralization and functional impairment in cancer patients; intensive metabolic monitoring and care of patients with schizophrenia; and social inclusion of patients with severe mental illness. Interim reports on the progress of these projects are available on the WPA website. The WPA has produced with Wiley-Blackwell, during the triennium, a series of books dealing with the recognition, epidemiology, pathogenesis, cultural aspects, medical costs and management of the comorbidity of depression with diabetes, heart disease and cancer 21,22,23. Three sets of slides based on these books have been produced and disseminated to Member Societies. The slides on depression and diabetes are available on the WPA website in 17 languages (English, French, Portuguese, Spanish, Italian, Estonian, Croatian, German, Swedish, Azeri, Bosnian, Romanian, Czech, Russian, Indonesian, Bangla and Japanese). The slides on depression and heart disease and those on depression and cancer are available in 8 languages. The WPA has also developed an educational module on physical illness in patients with severe mental disorders, which has been published in two parts in World Psychiatry 24,25 and posted on the Association's website. The module has been or is being translated into several languages. Two sets of slides based on this educational module have been produced and posted on the Association's website. An international task force has developed during the triennium a WPA template for undergraduate and postgraduate education in psychiatry and mental health, which has been posted on the WPA website and is being translated in several languages. Special sections of the Association's website have been devoted to continuing education of psychiatrists, education of the general public on mental health issues, and description of successful experiences in the mental health field. The WPA Committee on Ethics has developed a set of recommendations for relationships of psychiatrists, health care organizations working in the psychiatric field and psychiatric associations with the pharmaceutical industry. This document has been published in World Psychiatry 26 and posted on the WPA website. An international task force has produced a set of WPA recommendations on best practices in working with service users and family carers. This document appears in this issue of the journal 27. The WPA organized in 2009 and 2010 a series of train-the-trainers workshops aimed to contribute to the integration of mental health care into primary care in Nigeria and Sri Lanka. These workshops were conducted in collaboration with the national governments. They targeted nurses and clinical officers working in dispensaries and health centers, and were followed by a phase of supervision of participants 28. Detailed reports on the workshops are available on the WPA website. Educational courses dealing with issues of great relevance to psychiatric practice have been organized by the WPA in Abuja, Nigeria; Sao Paulo, Brazil; Dhaka, Bangladesh; St. Petersburg, Russia; Beijing, China; Cairo, Egypt; Yerevan, Armenia; and Istanbul, Turkey. Workshops on leadership and professional skills for young psychiatrists have been co-sponsored by the WPA in Singapore, Nigeria and Turkey. A WPA Early Career Psychiatrists Council has been established during the triennium. Its members have been appointed by WPA Member Societies and subdivided into five geographic areas (Europe I, Europe II, Asia/Australasia, Africa and Middle East, Americas), each with a coordinator. The Council has produced papers and documents for World Psychiatry 29 and the WPA website; organized symposia on the occasion of several scientific meetings; carried out surveys; participated in the translation and adaptation of the WPA slides on depression and physical diseases. The first personal meeting of the Council took place during the 15th World Congress of Psychiatry. During the triennium, the WPA has produced periodically press releases on topics relevant to mental health. Among those which have resulted in a wide media coverage are the releases focusing on two papers published in World Psychiatry: the report on the Iraq Mental Health Survey 30, covered in articles appearing in the International Herald Tribune, the New York Times and the Washington Post, and the paper on income-related inequalities in the prevalence of depression and suicide behaviour 31, covered in an article in USA Today. One more press release which led to a significant media coverage was that related to the WPA International Congress held in Florence in April 2009, focusing on the relationship between sleep problems and suicide, and resulting in articles published in the Guardian and the Daily Telegraph. The WPA has implemented during the triennium several other initiatives in collaboration with the WHO 32. In October 2009, the WPA and the WHO co-organized in Abuja, Nigeria a Policy Roundtable bringing together ministers of health, senior policy makers and professional leaders of the nine African countries identified in the WHO's Mental Health Gap Action Programme (mhGAP) as needing intensified support to scale up mental health services: Burundi, Cote d'Ivoire, Democratic Republic of Congo, Ethiopia, Ghana, Kenya, Liberia, Malawi and Nigeria. The outcome of the roundtable was the development of road maps for mental health care in those countries. WPA experts contributed to the production of the WHO's mhGAP Intervention Guide and the WHO's Atlas of Resources for the Prevention and Treatment of Substance Abuse. Many WPA Member Societies participated in the WPA Survey on Strategies to Reduce the Treatment Gap for Mental Disorders, whose results were published in full in World Psychiatry 33 and will be summarized in a paper in The Lancet 34. The WPA has assisted during the triennium many of its Member Societies in their interactions with national institutions concerning policy matters or refinement of educational curricula. Papers describing this collaboration have been published in partnership with the Czech Psychiatric Association, the Hungarian Psychiatric Association, the Brazilian Association of Psychiatry and the Portuguese Association of Psychiatry. The WPA has organized during the triennium scientific meetings in all continents, always in partnership with its Member Societies 35. The 15th World Congress of Psychiatry, organized in partnership with WPA Member Societies in Argentina, has been the most attended congress in the history of the Association. Many Congresses of Member Societies have been co-sponsored by the WPA and/or have included Symposia or CME Courses co-organized with the WPA. WPA leaders have met officially with leaders and/or members of Member Societies on the occasion of many national congresses, to discuss local priorities and provide advice. On several occasions, WPA leaders and leaders of Member Societies have held joint press conferences or participated in talk shows. In several WPA scientific meetings, seminars were organized in which leaders of selected Member Societies illustrated the structure and activities of their associations to representatives of other Member Societies, answered their questions and provided advice on specific issues. The WPA has implemented during the triennium an initiative to support the development of national psychiatric journals in low- and middle-income countries. A task force has worked with editors of selected journals to strengthen their chances of being indexed in international databases 36. Several journals whose editors participated in this project have recently achieved indexation. The activities of the Action Plan have been supported by a consortium of industry and non-industry donors. The donors have had no input on the contents of the Plan and the selection of people participating in its implementation. No activity within the Action Plan has been mono-sponsored.

HomeCirculationVol. 83, No. 1An updated coronary risk profile. A statement for health professionals. Free AccessAbstractPDF/EPUBAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessAbstractPDF/EPUBAn updated coronary risk profile. A statement for health professionals. K M Anderson, P W Wilson, P M Odell and W B Kannel K M AndersonK M Anderson Office of Scientific Affairs, American Heart Association, Dallas, TX 75231. , P W WilsonP W Wilson Office of Scientific Affairs, American Heart Association, Dallas, TX 75231. , P M OdellP M Odell Office of Scientific Affairs, American Heart Association, Dallas, TX 75231. and W B KannelW B Kannel Office of Scientific Affairs, American Heart Association, Dallas, TX 75231. Originally published1 Jan 1991https://doi.org/10.1161/01.CIR.83.1.356Circulation. 1991;83:356–362 Previous Back to top Next FiguresReferencesRelatedDetailsCited By Hespe C, Giskes K, Harris M and Peiris D (2022) Findings and lessons learnt implementing a cardiovascular disease quality improvement program in Australian primary care: a mixed method evaluation, BMC Health Services Research, 10.1186/s12913-021-07310-6, 22:1, Online publication date: 1-Dec-2022. Lemke E, Vetter V, Berger N, Banszerus V, König M and Demuth I (2022) Cardiovascular health is associated with the epigenetic clock in the Berlin Aging Study II (BASE-II), Mechanisms of Ageing and Development, 10.1016/j.mad.2021.111616, 201, (111616), Online publication date: 1-Jan-2022. 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Timely and comprehensive analyses of causes of death stratified by age, sex, and location are essential for shaping effective health policies aimed at reducing global mortality. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 provides cause-specific mortality estimates measured in counts, rates, and years of life lost (YLLs). GBD 2023 aimed to enhance our understanding of the relationship between age and cause of death by quantifying the probability of dying before age 70 years (70q0) and the mean age at death by cause and sex. This study enables comparisons of the impact of causes of death over time, offering a deeper understanding of how these causes affect global populations. GBD 2023 produced estimates for 292 causes of death disaggregated by age-sex-location-year in 204 countries and territories and 660 subnational locations for each year from 1990 until 2023. We used a modelling tool developed for GBD, the Cause of Death Ensemble model (CODEm), to estimate cause-specific death rates for most causes. We computed YLLs as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. Probability of death was calculated as the chance of dying from a given cause in a specific age period, for a specific population. Mean age at death was calculated by first assigning the midpoint age of each age group for every death, followed by computing the mean of all midpoint ages across all deaths attributed to a given cause. We used GBD death estimates to calculate the observed mean age at death and to model the expected mean age across causes, sexes, years, and locations. The expected mean age reflects the expected mean age at death for individuals within a population, based on global mortality rates and the population's age structure. Comparatively, the observed mean age represents the actual mean age at death, influenced by all factors unique to a location-specific population, including its age structure. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 250-draw distribution for each metric. Findings are reported as counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2023 include a correction for the misclassification of deaths due to COVID-19, updates to the method used to estimate COVID-19, and updates to the CODEm modelling framework. This analysis used 55 761 data sources, including vital registration and verbal autopsy data as well as data from surveys, censuses, surveillance systems, and cancer registries, among others. For GBD 2023, there were 312 new country-years of vital registration cause-of-death data, 3 country-years of surveillance data, 51 country-years of verbal autopsy data, and 144 country-years of other data types that were added to those used in previous GBD rounds. The initial years of the COVID-19 pandemic caused shifts in long-standing rankings of the leading causes of global deaths: it ranked as the number one age-standardised cause of death at Level 3 of the GBD cause classification hierarchy in 2021. By 2023, COVID-19 dropped to the 20th place among the leading global causes, returning the rankings of the leading two causes to those typical across the time series (ie, ischaemic heart disease and stroke). While ischaemic heart disease and stroke persist as leading causes of death, there has been progress in reducing their age-standardised mortality rates globally. Four other leading causes have also shown large declines in global age-standardised mortality rates across the study period: diarrhoeal diseases, tuberculosis, stomach cancer, and measles. Other causes of death showed disparate patterns between sexes, notably for deaths from conflict and terrorism in some locations. A large reduction in age-standardised rates of YLLs occurred for neonatal disorders. Despite this, neonatal disorders remained the leading cause of global YLLs over the period studied, except in 2021, when COVID-19 was temporarily the leading cause. Compared to 1990, there has been a considerable reduction in total YLLs in many vaccine-preventable diseases, most notably diphtheria, pertussis, tetanus, and measles. In addition, this study quantified the mean age at death for all-cause mortality and cause-specific mortality and found noticeable variation by sex and location. The global all-cause mean age at death increased from 46·8 years (95% UI 46·6-47·0) in 1990 to 63·4 years (63·1-63·7) in 2023. For males, mean age increased from 45·4 years (45·1-45·7) to 61·2 years (60·7-61·6), and for females it increased from 48·5 years (48·1-48·8) to 65·9 years (65·5-66·3), from 1990 to 2023. The highest all-cause mean age at death in 2023 was found in the high-income super-region, where the mean age for females reached 80·9 years (80·9-81·0) and for males 74·8 years (74·8-74·9). By comparison, the lowest all-cause mean age at death occurred in sub-Saharan Africa, where it was 38·0 years (37·5-38·4) for females and 35·6 years (35·2-35·9) for males in 2023. Lastly, our study found that all-cause 70q0 decreased across each GBD super-region and region from 2000 to 2023, although with large variability between them. For females, we found that 70q0 notably increased from drug use disorders and conflict and terrorism. Leading causes that increased 70q0 for males also included drug use disorders, as well as diabetes. In sub-Saharan Africa, there was an increase in 70q0 for many non-communicable diseases (NCDs). Additionally, the mean age at death from NCDs was lower than the expected mean age at death for this super-region. By comparison, there was an increase in 70q0 for drug use disorders in the high-income super-region, which also had an observed mean age at death lower than the expected value. We examined global mortality patterns over the past three decades, highlighting-with enhanced estimation methods-the impacts of major events such as the COVID-19 pandemic, in addition to broader trends such as increasing NCDs in low-income regions that reflect ongoing shifts in the global epidemiological transition. This study also delves into premature mortality patterns, exploring the interplay between age and causes of death and deepening our understanding of where targeted resources could be applied to further reduce preventable sources of mortality. We provide essential insights into global and regional health disparities, identifying locations in need of targeted interventions to address both communicable and non-communicable diseases. There is an ever-present need for strengthened health-care systems that are resilient to future pandemics and the shifting burden of disease, particularly among ageing populations in regions with high mortality rates. Robust estimates of causes of death are increasingly essential to inform health priorities and guide efforts toward achieving global health equity. The need for global collaboration to reduce preventable mortality is more important than ever, as shifting burdens of disease are affecting all nations, albeit at different paces and scales. Gates Foundation.

ObjectiveIndia faces a critical shortage of mental health professionals, leaving primary care physicians (PCPs) as the primary point of contact for many individuals needing psychiatric care. The Diploma in Primary Care Psychiatry Program (DPCP), a one-year training initiative, aims to equip PCPs in India to manage psychiatric conditions in underserved areas. On-Consultation Training (OCT) is a module in the DPCP designed exclusively for practicing PCPs where a psychiatrist trains PCPs in live video streaming of their own real-time general consultations of primary health centres. This study identifies a training gap within the DPCP.MethodsPCPs (n = 62) from Uttarakhand, Bihar, and Karnataka states in India received training in the DPCP from 2019 to 2024. Assessed were their exposure to six psychiatric disorders (tobacco addiction, alcohol addiction, psychosis, somatization disorder, anxiety disorder, and depressive disorder) during On-Consultation Training (OCT) sessions. Adequate training per doctor was defined as encountering at least two patients with each disorder.ResultsA total of 650 psychiatric cases seen during OCT sessions were reviewed. Only tobacco addiction and depressive disorder met the training adequacy benchmark (exposure to two cases with the disorder). Alcohol addiction, psychosis, somatization disorder, and anxiety disorders fell below the threshold, highlighting a specific training gap.ConclusionsThis study identified a training gap in the DPCP. The restructuring of the Collaborative Video Consultation (CVC) module with case-specific quotas, expert case demonstrations, and enhanced real-time feedback during OCT could help close this and other training gaps. Addressing these issues will better prepare PCPs in India to manage a broader range of psychiatric conditions, enhancing mental health care delivery in primary care settings.

ObjectiveBreast cancer patients undergoing radiotherapy frequently experience psychological distress that negatively impacts treatment outcomes and quality of life. Evidence for structured psychological interventions during radiotherapy remains limited. This study evaluated the longitudinal effects of a structured education plus entertainment therapy intervention on anxiety, depression, and quality of life in mainland China breast cancer patients during and after radiotherapy using linear mixed model analysis.MethodsThis single-center, parallel-group, assessor-blinded randomized controlled trial enrolled 280 female breast cancer patients (aged 18-75 years) receiving adjuvant radiotherapy. Participants were randomized 1:1 to intervention (structured education plus entertainment therapy) or control (standard care). Primary outcomes were Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) trajectories assessed at baseline (T0), mid-radiotherapy (T1), end of radiotherapy (T2), and 1, 3, and 6 months post-radiotherapy (T3-T5). Secondary outcomes included quality of life (EORTC QLQ-C30/BR23 domains), acute toxicity (CTCAE v5.0), and adherence. Linear mixed models with group &#xd7; time interaction assessed intervention effects.ResultsOf 280 randomized patients, 252 (90%) completed the T5 assessment. The intervention group showed significantly improved SAS trajectory (group &#xd7; time interaction &#x3b2; = -1.82, 95% CI: -3.14 to -0.50, P = 0.007) with estimated marginal mean difference of -3.45 points at T5. SDS trajectory improvement was marginally significant (&#x3b2; = -1.56, 95% CI: -3.12 to 0.01, P = 0.051). Minimal clinically important difference (MCID, &#x2265;0.5 SD improvement) was achieved by 48.6% vs 31.4% for anxiety (P = 0.004) and 42.1% vs 29.3% for depression (P = 0.027) for intervention and control groups, respectively. Global health status improved significantly (&#x3b2; = 4.23, P < 0.001). Grade &#x2265;2 radiation dermatitis occurred in 37.1% vs 48.6% (P = 0.055) in intervention and control groups, respectively. High adherence (&#x2265;70% sessions) in 72.1% of intervention patients was associated with greater benefits.ConclusionsThe structured education plus entertainment therapy intervention demonstrated small-to-moderate clinically meaningful improvements in anxiety, depression, and quality of life during radiotherapy, with effects persisting through 6-month follow-up. Implementation into routine radiotherapy care of breast cancer patients in China appears feasible and effective.

ObjectiveChronic pain and depression are common in older adults, yet pain is dynamic and may follow distinct longitudinal courses. This study examined whether chronic pain trajectories are associated with incident depressive symptoms among adults aged 50 years and older.MethodsAnalyzed were two prospective cohorts of community-dwelling adults: the English Longitudinal Study of Ageing (ELSA) and the US Health and Retirement Study (HRS). Biennial self-reported pain (yes/no) across four waves was used to classify five mutually exclusive pain trajectories: no pain, decreasing pain, fluctuating pain, increasing pain, and consistent pain. Participants with depressive symptoms at baseline were excluded. Incident depressive symptoms were defined as a Center for Epidemiologic Studies Depression scale (CESD-8) score &#x2265;3. Cox proportional hazards models estimated hazard ratios (HRs) adjusted for sociodemographic characteristics, health behaviors, and chronic conditions.ResultsThe analytic samples included 2476 participants in ELSA and 6238 in HRS, with a mean follow-up of 6.3 years and 6.1 years, respectively; incident depressive symptoms occurred in 19.7% and 18.3%, respectively. Compared with the no-pain trajectory, fluctuating, increasing, and consistent pain were associated with higher risk of depressive symptoms in ELSA (HRs, 1.70 [95% CI, 1.37-2.10], 1.76 [95% CI, 1.27-2.45], and 2.60 [95% CI, 1.98-3.43], respectively) and HRS (HRs, 1.48 [95% CI, 1.29-1.71], 1.84 [95% CI, 1.47-2.29], and 2.15 [95% CI, 1.78-2.59], respectively). Decreasing pain was not significantly associated with risk in either cohort.ConclusionsPersistent or worsening pain trajectories were consistently predicted subsequent depressive symptoms in older adults, whereas improving pain was not. Longitudinal pain monitoring may help identify high-risk individuals through earlier depression screening, along with integrated pain-mental health care.

ObjectiveThis narrative review examines the intersection of serial infidelity, coercive control, and psychological abuse as an under-recognised form of betrayal trauma.MethodsGuided by PRISMA principles, a systematic search of four databases (PsycINFO, PubMed, Scopus, and Web of Science) identified 47 peer-reviewed studies published between 1990 and 2025 that met inclusion criteria. Studies were included if they examined repeated infidelity within intimate relationships, associated patterns of coercive control, gaslighting (defined here as psychologically manipulating a person into questioning their own perceptions, memory, or sanity), or the psychological sequelae of sustained relational betrayal. Data were analysed using a narrative synthesis approach to identify convergent theoretical, clinical, and diagnostic themes.ResultsFindings indicate that serial infidelity frequently co-occurs with coercive and gaslighting behaviours, producing psychological effects consistent with trauma responses observed in intimate partner violence. Despite these effects, relational betrayal involving sustained deception and control remains largely absent from psychiatric nosology, contributing to diagnostic blind spots and therapeutic misclassification.ConclusionThis review highlights the distinction between moral judgement of behaviour and the clinical recognition of trauma-based harm. An evidence-informed framework is proposed for identifying betrayal trauma within diagnostic and clinical settings, emphasising trauma-informed assessment and intervention rather than behavioural or personality-based explanations.

IntroductionIndividuals with serious mental illness (SMI), including major depression, schizophrenia, and bipolar disorder, experience disproportionately high rates of cardiovascular (CV) risk and disease. Despite this well-established connection, it remains unclear how professional society guidelines across cardiology and psychiatry address this relationship.MethodsMajor American and European CV and psychiatric society guidelines published from 2013-2023 were reviewed. Included were guidelines on primary and secondary CV disease prevention, and disease-specific guidelines for schizophrenia, bipolar disorder, and major depressive disorder. Relevant text was extracted and classified as recommendations or supporting text.ResultsTwenty-six guidelines were included (13 CV; 13 psychiatric). Psychiatric considerations appeared in 5 CV guidelines (38%), most commonly addressing mental illness treatment to improve CV outcomes (n = 5), pharmacological considerations (n = 2), and recognition of mental illness as a CV risk factor (n = 2). Only 13% of American CV guidelines included psychiatric content, compared to 80% of European CV guidelines. In contrast, 10 psychiatric guidelines (77%) included CV-related recommendations, including CV screening (n = 16), pharmacological considerations (n = 8), and risk factor control (n = 7). Among psychiatric guidelines, 40% of U.S. and 100% of European documents included CV content.ConclusionsCV considerations are more frequently addressed in psychiatric than psychiatric considerations in CV guidelines. European guidelines showed greater cross-disciplinary integration. These findings highlight the need for more unified, interdisciplinary guidance to reduce CV risk in individuals with SMI.

ObjectiveTo evaluate the effects of a combined psychological and functional exercise intervention on emotion, quality of life, and brain-derived neurotrophic factor (BDNF) levels in patients with Parkinson's disease (PD).MethodsIn this randomized controlled trial, 172 patients with PD were randomly assigned into 2 groups with 86 patients in each group. The control group received routine care, while the intervention group received a 12-week intervention combining psychological support with functional exercise in addition to routine care. Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), Parkinson's Disease Questionnaire-39 (PDQ-39), Barthel Index, Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), and serum BDNF levels were assessed before and after the intervention. Adherence rates were also determined for each group. Spearman correlation analysis was used to examine associations between changes in BDNF (&#x394;BDNF) and changes in HAMA (&#x394;HAMA) and HAMD (&#x394;HAMD) scores.ResultsAt the end of the 12-week clinical trial, the intervention group demonstrated significantly lower HAMA, HAMD, PDQ-39, and MDS-UPDRS scores (P < 0.001), and higher Barthel Index scores and BDNF levels compared to the control group. The adherence rate in the intervention group was higher than in the control group (90.70% vs 76.74%, respectively, P = 0.01).ConclusionA combined psychological and functional exercise intervention significantly improved emotional well-being, quality of life, daily functioning, adherence, and BDNF levels (compared to the control group) in patients with PD. Based on these findings, this multi-component intervention may have value in treating PD patients.