Background Community‐based primary‐level workers (PWs) are an important strategy for addressing gaps in mental health service delivery in low‐ and middle‐income countries. Objectives To evaluate the effectiveness of PW‐led treatments for persons with mental health symptoms in LMICs, compared to usual care. Search methods MEDLINE, Embase, CENTRAL, ClinicalTrials.gov, ICTRP, reference lists (to 20 June 2019). Selection criteria Randomised trials of PW‐led or collaborative‐care interventions treating people with mental health symptoms or their carers in LMICs. PWs included: primary health professionals (PHPs), lay health workers (LHWs), community non‐health professionals (CPs). Data collection and analysis Seven conditions were identified apriori and analysed by disorder and PW examining recovery, prevalence, symptom change, quality‐of‐life (QOL), functioning, service use (SU), and adverse events (AEs). Risk ratios (RRs) were used for dichotomous outcomes; mean difference (MDs), standardised mean differences (SMDs), or mean change differences (MCDs) for continuous outcomes. For SMDs, 0.20 to 0.49 represented small, 0.50 to 0.79 moderate, and ≥0.80 large clinical effects. Analysis timepoints: T1 (<1 month), T2 (1‐6 months), T3 ( >6 months) post‐intervention. Main results Description of studies 95 trials (72 new since 2013) from 30 LMICs (25 trials from 13 LICs). Risk of bias Most common: detection bias, attrition bias (efficacy), insufficient protection against contamination. Intervention effects *Unless indicated, comparisons were usual care at T2. “Probably”, “may”, or “uncertain” indicates "moderate", "low," or "very low" certainty evidence. Adults with common mental disorders (CMDs) LHW‐led interventions a. may increase recovery (2 trials, 308 participants; RR 1.29, 95%CI 1.06 to 1.56); b. may reduce prevalence (2 trials, 479 participants; RR 0.42, 95%CI 0.18 to 0.96); c. may reduce symptoms (4 trials, 798 participants; SMD ‐0.59, 95%CI ‐1.01 to ‐0.16); d. may improve QOL (1 trial, 521 participants; SMD 0.51, 95%CI 0.34 to 0.69); e. may slightly reduce functional impairment (3 trials, 1399 participants; SMD ‐0.47, 95%CI ‐0.8 to ‐0.15); f. may reduce AEs (risk of suicide ideation/attempts); g. may have uncertain effects on SU. Collaborative‐care a. may increase recovery (5 trials, 804 participants; RR 2.26, 95%CI 1.50 to 3.43); b. may reduce prevalence although the actual effect range indicates it may have little‐or‐no effect (2 trials, 2820 participants; RR 0.57, 95%CI 0.32 to 1.01); c. may slightly red...

Recently, mental health and ill health have been reframed to be seen as a continuum from health to ill health, through the stages of being asymptomatic ‘at risk’, to experiencing ‘mental distress’, ‘sub-syndromal symptoms’ and finally ‘mental disorders’. This new conceptualisation emphasised the importance of mental health promotion and prevention interventions, aimed at reducing the likelihood of future disorders with the general population or with people who are identified as being at risk of a disorder. This concept generated discussion on the distinction between prevention and treatment interventions, especially for those mental health conditions which lie between psychological distress and a formal psychiatric diagnosis. The present editorial aims to clarify the definition of promotion, prevention and treatment interventions delivered through a task-shifting approach according to a global mental health perspective.

Introduction: Pre-hospital care covers assistance and immediate care to injured and seriously ill patients at the scene and during transfer to health facilities. Pre-hospital care demands skills and preparedness. Medical emergencies involve use of a range of transports other than ambulances in Nepal. The current pilot study aimed to explore the access to pre-hospital care and factors associated with it from both users and providers’ perspective. Method: Cross sectional concurrent parallel mixed method study was done in emergency department (ED) of Patan Hospital, Nepal. Semi-structured questionnaire and interview guides were used. Thirty patients and visitors arriving at ED and seven key informants participated. Permission was taken from ED and written informed consent was taken. Descriptive and inferential statistics was done using R software and thematic analysis was done using EZR package. Result: Proportion of access to pre-hospital (PH) care was found to be 13.3% (4 out of 30). Concept of pre-hospital care itself is not popular among users. Limited PH care and service was found in the study site. Cost of transportation and distance between site and hospital were found to be associated with access. Further to it, barriers and facilitators were related with service delivery, workforce, financing, infrastructure, communication, coordination and information.   Conclusion: Access to pre-hospital services was found only in 4 out 30 patients. Awareness among the users’ and integrated governance of ambulances is recommended for improvement of pre-hospital services. Keywords: Ambulance, emergency medical services, pre-hospital care, tertiary hospital, Nepal

Introduction: Vehicle drivers are most significant stakeholder in any road traffic accident (RTAs). This study aims to assess their knowledge related to traffic signs and attitude towards safe driving practices and to identify self-reported risky driving behaviors, their encounter of RTAs, and associated factors. Methods: We carried out a cross-sectional study in Kathmandu valley. 14 prime spots were randomly selected and time location sampling was done. A face-to-face interview was done with public vehicle drivers using  structured questionnaire. We analyzed the association using logistic regression. Ethical clearance was obtained from Institute of Medicine. Informed written consent was taken from the participants. Results: Of 411 drivers, mean age was 31.8 (±8.2) years. All participants were male of which 71.0% lived in a joint family. More than half had less than 10 year experience and 20% of them were driving 12-18 hours per day. Half of them had good knowledge on traffic signs while nearly one tenth had non-supportive attitude towards safe driving practices. Prevalence of at least one risky driving behavior was 68%, however, only a few cases fined by traffic. Self-reported encounters of RTA were 21.7%; of these, 22.2% also had human injuries. Experiences of driving less than 10 years and living in a nuclear family were significantly associated with risky driving. Moreover, age of public vehicle drivers less than 25 years, living in nuclear family and continuing driving while fatigue were also significantly associated with RTAs. Conclusion: Only half of drivers had good knowledge on traffic signs. Risky driving behavior present in about seven among ten public vehicle drivers and two among ten encountering RTAs. We recommend interventions targeted to change behavior among drivers to reduce risky driving behaviors, to increase age bar for permitting driving license for public vehicles and not continuing driving while fatigue to reduce RTAs.