***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Type 2 diabetes ( T2DM ) affects 113.9 million people in China , the largest number of any country in the world ( JAMA 310:948–59 , 2013 ) . T2DM prevalence has risen dramatically from around 1 % in the 1980s to now over 10 % and is expected to continue rising . Despite the growing disease burden , few people with T2DM are achieving adequate management targets to prevent complications . Health system infrastructure in China is struggling to meet these gaps in care , and innovative , cost-effective and affordable solutions are needed . One promising strategy that may be particularly relevant to the Chinese context is improving support for lay family members to care for their relatives with T2DM . Methods We hypothesise that an interactive mobile health management system can support lay family health promoters ( FHP ) and healthcare staff to improve clinical outcomes for family members with T2DM through medical assessment , regular monitoring , lifestyle advice and the prescribing of guidelines recommended medications . This intervention will be implemented as a cluster r and omised controlled trial involving 80 communities ( 40 communities in Beijing and 40 rural villages in Hebei province ) and 2000 people with T2DM . Outcome analyses will be conducted blinded to intervention allocation . The primary outcome is the proportion of patients achieving ≥2 “ ABC ” goals ( HbA1c < 7.0 % , blood pressure ( BP ) < 140/80 mmHg and LDL cholesterol < 100 mg/dl or 2.6 mmol/L ) at the end of follow-up ( Diabetes Care 36(Supplement 1):S11-S66 , 2013 ) . Secondary outcomes include the proportion of patients achieving individual ABC targets ; mean changes in HbA1c , BP , LDL , renal function ( serum creatinine and urinary albumin ) , body mass index , quality of life ( QOL , EQ-5D ) , and healthcare utilisation from baseline ; and cost-effectiveness/utility of intervention . Trial outcomes will be accompanied by detailed process and economic evaluations . Discussion The Chinese government has prioritised prevention and treatment of diabetes as 1 of 11 National Basic Public Health Services . Despite great promise for mHealth interventions to improve access to effective health care , there remains uncertainty about how this can be successfully achieved . The findings are likely to inform policy on a scalable strategy to overcome sub-optimal access to effective health care in China . Trial registration Clinical trials.gov In China , one of the major problems in upgrading rural health services is the difficulty of communicating between the rural and urban areas . Enabling local agencies to access the Internet in re source -poor areas can provide an efficient means of diffusing current training and information and will have far-reaching policy implication s. To test the feasibility of using the Internet to deliver needed health information to the countryside , the UCLA School of Public Health and the Institute of Health Studies of Kunming Medical College ( IHS-KMC ) collaborated in an experimental website project to improve the quality of reproductive health services to promote women 's health in three rural counties of Yunnan . The project involved the county government and the Bureau of Public Health , the Bureau of Family Planning ; the Bureau of Education , Women 's Federation , and the Maternal and Child Health Station targeting village health workers and teachers ; women 's cadres . Three counties , matched on socioeconomic status , participated in the study and were r and omized to receive three programs . Nanhua County received computer skill training and logistic support including a planning workshop for information diffusion . Mouding County received computers only . Dayao , the control county , did not receive the full program until the conclusion of the project . The study demonstrated that the use of a website to disseminate health information in remote rural areas is not only feasible but that it also will be enthusiastically adopted by local health workers and interested parties . Moreover , the knowledge was diffused from the primary population of village doctors , family planning workers , women 's cadres , and teachers to the secondary population of villagers and students Background Latin America , China and India are experiencing unprecedentedly rapid demographic ageing with an increasing number of people with dementia . The 10/66 Dementia Research Group 's title refers to the 66 % of people with dementia that live in developing countries and the less than one tenth of population -based research carried out in those setting s. This paper describes the protocol s for the 10/66 population -based and intervention studies that aim to redress this imbalance . Methods / design Cross-sectional comprehensive one phase surveys have been conducted of all residents aged 65 and over of geographically defined catchment areas in ten low and middle income countries ( India , China , Nigeria , Cuba , Dominican Republic , Brazil , Venezuela , Mexico , Peru and Argentina ) , with a sample size of between 1000 and 3000 ( generally 2000 ) . Each of the studies uses the same core minimum data set with cross-culturally vali date d assessment s ( dementia diagnosis and subtypes , mental disorders , physical health , anthropometry , demographics , extensive non communicable disease risk factor question naires , disability/functioning , health service utilisation , care arrangements and caregiver strain ) . Nested within the population based studies is a r and omised controlled trial of a caregiver intervention for people with dementia and their families ( IS RCT N41039907 ; IS RCT N41062011 ; IS RCT N95135433 ; IS RCT N66355402 ; IS RCT N93378627 ; IS RCT N94921815 ) . A follow up of 2.5 to 3.5 years will be conducted in 7 countries ( China , Cuba , Dominican Republic , Venezuela , Mexico , Peru and Argentina ) to assess risk factors for incident dementia , stroke and all cause and cause-specific mortality ; verbal autopsy will be used to identify causes of death . Discussion The 10/66 DRG baseline population -based studies are nearly complete . The incidence phase will be completed in 2009 . All investigators are committed to establish an anonymised file sharing archive with monitored public access . Our aim is to create an evidence base to empower advocacy , raise awareness about dementia , and ensure that the health and social care needs of older people are anticipated and met Pregnancy is a condition exhibiting increased susceptibility to oxidative stress , and Fe plays a central role in generating harmful oxygen species . The objective of the present study is to investigate the changes in haematological status , oxidative stress and erythrocyte membrane fluidity in anaemic pregnant women after Fe supplementation with and without combined vitamins .  The study was a 2 months double-blind , r and omised trial . Pregnant women ( n 164 ) were allocated to four groups : group C was the placebo control group ; group I was supplemented daily with 60 mg Fe ( ferrous sulphate ) daily ; group IF was supplemented daily with Fe plus 400 μg folic acid ; group IM was supplemented daily with Fe plus 2 mg retinol and 1 mg riboflavin , respectively . After the 2-month trial , Hb significantly increased by 15.8 , 17.3 and 21.8 g/l , and ferritin by 2.8 , 3.6 and 11.0 μg/l , in the I , IF and IM groups compared with placebo . Polarisation ( ρ ) and microviscosity ( η ) decreased significantly in other groups compared with placebo , indicating an increase in membrane fluidity . Significant decreases of ρ and η values compared with group C were 0.033 and 0.959 for group I , 0.037 and 1.074 for group IF and 0.064 and 1.865 for group IM , respectively . In addition , significant increases of glutathione peroxidase activities and decreases of malondialdehyde were shown in all treated groups , as well as increases of plasma retinol and urine riboflavin in group IM . The findings show that supplementation with Fe and particularly in combination with vitamins  could improve the haematological status as well as oxidative stress and erythrocyte membrane fluidity Background Being an intermediate stage in the development of diabetes , pre-diabetics were estimated as high as 14 % to 63 % in China and one to three quarters of them will develop into diabetes within 10 years . It is well established that the risk of diabetes progression can be modified substantially and a whole range of proven guidelines , protocol s and method ologies are available . Unfortunately , most proven interventions are seldom used in daily practice and this is especially true in re source poor rural China . This project aims at demonstrating that an evolutionary intervention package featuring low cost , integration with routine services , cultural sensitization and self-optimization , is effective and sustainable in preventing diabetes . Methods / design This project utilizes a quasi cluster r and omized controlled trial and a batched implementation strategy in which villages are recruited in 7 blocks within 7 consecutive years respectively . Block 0 involves 3 villages and provides an opportunity for piloting and refining primitive intervention method ologies and protocol s. The following 6 blocks consist of 14 villages each and serve as  intervention  arm ; while all the villages not yet started intervention form the  control arm . For each block , measurement happens at baseline and every 12 months ( for plasma glucose ) or monthly ( for body weight and blood pressure ) after baseline . These arrangements enable documentation of up to 6 years of consecutive measures and detection of lower incidence of progression into diabetes , improved body max index and blood pressure , and increased service use and involvement in healthy dietary and physical activities among pre-diabetics receiving the experimental intervention compared to themselves at baseline or those in the delayed-intervention control condition . Discussion China has a long history of separating disease prevention and treatment systems and there is a clear need to leverages key success factors in a synergetic way toward integrated and sustainable diabetes prevention . This project is owned and managed by local health authorities and utilizes available re sources . It introduces a package of long-term incentives , establishes ongoing mechanisms for continuous capacity building and quality improvement , and builds up an operational cycle for catalyzing similar efforts in the local prefecture even throughout rural China . Trial registration Current Controlled Trials : IS RCT N66772711 Introduction Schizophrenia is a severe , chronic and disabling mental illness . Non-adherence to medication and relapse may lead to poorer patient function . This r and omised controlled study , under the acronym LEAN ( Lay health supporter , e-platform , award , and iNtegration ) , is design ed to improve medication adherence and high relapse among people with schizophrenia in re source poor setting s. Methods / analysis The community-based LEAN has four parts : ( 1 ) Lay health supporters ( LHSs ) , mostly family members who will help supervise patient medication , monitor relapse and side effects , and facilitate access to care , ( 2 ) an E-platform to support two-way mobile text and voice messaging to remind patients to take medication ; and alert LHSs when patients are non-adherent , ( 3 ) an Award system to motivate patients and strengthen LHS support , and ( 4 ) iNtegration of the efforts of patients and LHSs with those of village doctors , township mental health administrators and psychiatrists via the e-platform . A r and om sample of 258 villagers with schizophrenia will be drawn from the schizophrenic ‘ 686 ’ Program registry for the 9 Xiang dialect towns of the Liuyang municipality in China . The sample will be further r and omised into a control group and a treatment group of equal sizes , and each group will be followed for 6 months after launch of the intervention . The primary outcome will be medication adherence as measured by pill counts and supplemented by pharmacy records . Other outcomes include symptoms and level of function . Outcomes will be assessed primarily when patients present for medication refill visits scheduled every 2 months over the 6-month follow-up period . Data from the study will be analysed using analysis of covariance for the programme effect and an intent-to-treat approach . Ethics and dissemination University of Washington : 49464 G ; Central South University : CTXY-150002 - 6 . Results will be published in peer- review ed journals with deidentified data made available on FigShare . Trial registration number ChiCTR-ICR-15006053 ; Pre- results OBJECTIVE To prevent perinatal transmission of hepatitis B virus ( HBV ) , WHO recommends that the first dose of hepatitis B ( HepB ) vaccine be given within 24 hours after birth . This presents a challenge in remote areas with limited cold-chain infrastructure and where many children are born at home . METHODS Rural townships in three counties in China 's Hunan Province were r and omized into three groups with different strategies for delivery of the first dose of HepB vaccine . In group 1 , vaccine was stored within the cold chain and administered in township hospitals . In group 2 , vaccine was stored out of the cold chain in villages and administered by village-based health workers to infants at home . Group 3 used the same strategy as group 2 , but vaccine was packaged in a prefilled injection device . Training of immunization providers and public communication conveying the importance of the birth dose was performed for all groups . FINDINGS Among children born at home , timely administration ( within 24 hours after birth ) of the first dose of HepB vaccine  increased in all groups after the study : group 1 , from 2.4 % to 25.2 % ; group 2 , from 2.6 % to 51.8 % ; and group 3 , from 0.6 % to 66.7 % ; P < 0.001 in each case . No significant difference in antibody response to vaccine was observed between the groups . CONCLUSION Timely administration of the first dose of HepB vaccine  was improved by communication and training activities , and by out-of-cold-chain storage of vaccine and administration at the village level , especially among children born at home 
    Output:
    
Barriers challenging the sustainability of the CHWs led projects were transportation , nature of official support , quantity and quality of CHWs , training of CHWs , incentives for CHWs , and maintaining a good rapport between CHWs and target population .
Conclusion CHWs appear to frequently engage in implementing diverse public health intervention programs in China .
Facilitators and barriers identified are comparable to those identified in high income countries .