Perinatal Mental Health Task Force: Integrating Care Across a Pediatric Hospital Setting.

Perinatal mood and anxiety disorders (PMADs) are the most common complication of childbirth, with suicide a leading cause of postpartum deaths. PMADs are associated with poor maternal, infant, and family outcomes. Identification and early intervention are imperative for successful treatment. This case study describes the implementation and outcomes of a multidisciplinary Perinatal Mental Health Task Force ("Task Force") at one urban academic children's hospital that was created to promote systems change and health care policy solutions for improved identification and treatment of PMADs. Using the social ecological model as a framework, the Task Force addressed care at the individual, interpersonal, organizational, community, and policy levels. The Task Force applied lessons learned from division-specific screening initiatives to create best practices and make hospital-wide recommendations. This foundational work enabled us to build community bridges and break down internal barriers to shift our pediatric hospital toward prioritizing perinatal mental health. As a result, screening expanded to multiple hospital locations and became a hospital corporate goal, the Perinatal Mental Health Screening Tool Kit was created and disseminated within the community, Task Force members testified in governmental hearings and joined national organizations to inform policy, and Task Force and community collaborations resulted in significant grant funding. Lessons learned have been disseminated nationally. Moving forward, we aim to expand our program and partnerships to ensure that caregivers of infants receive appropriate mental health support to strengthen family well-being. The Task Force can serve as a model for advocates looking to expand and integrate PMAD care.

Children and Adolescent Mental Health in a Time of COVID-19: A Forgotten Priority.

Globally, 10-20% of children and adolescents experience mental health conditions, but most of them do not receive the appropriate care when it is needed. The COVID-19 deaths and prevention measures, such as the lockdowns, economic downturns, and school closures, have affected many communities physically, mentally, and economically and significantly impacted the already-neglected children and adolescents' mental health. As a result, evidence has shown that many children and adolescents are experiencing psychological effects such as depression and anxiety without adequate support. The consequences of not addressing the mental health conditions in children and adolescents extend through adulthood and restrict them from reaching their full potential. The effects of COVID-19 on children and adolescents' mental health highlight the urgent need for multisectoral home-grown solutions to provide early diagnosis and treatment and educate caregivers on home-based interventions and community outreach initiatives to address children and adolescents' mental health challenges during this pandemic and beyond.

Homozygous Familial Hypercholesterolemia.

Familial hypercholesterolemia (FH) is an inherited disorder with retarded clearance of plasma LDL caused by mutations of the genes involved in the LDL receptor-mediated pathway and most of them exhibit autosomal dominant inheritance. Homozygotes of FH (HoFH) may have plasma LDL-C levels, which are at least twice as high as those of heterozygous FH (HeFH) and therefore four times higher than normal levels. Prevalence of HoFH had been estimated as 1 in 1,000,000 before but more recent genetic analysis surveys predict 1 in 170,000 to 300,000. Since LDL receptor activity is severely impaired, HoFH patients do not or very poorly respond to medications to enhance activity, such as statins, and have a poorer prognosis compared to HeFH. HoFH should therefore be clinically distinguished from HeFH. Thorough family studies and genetic analysis are recommended for their accurate diagnosis.Fatal cardiovascular complications could develop even in the first decade of life for HoFH, so aggressive lipid-lowering therapy should be initiated as early as possible. Direct removal of plasma LDL by lipoprotein apheresis has been the principal measure for these patients. However, this treatment alone may not achieve stable LDL-C target levels and combination with drugs should be considered. The lipid-lowering effects of statins and PCSK9 inhibitors substantially vary depending on the remaining LDL receptor activity of individual patients. On the other hand, the action an MTP inhibitor is independent of LDL receptor activity, and it is effective in most HoFH cases.This review summarizes the key clinical issues of HoFH as well as insurance coverage available under the Japanese public healthcare system.

Ecological Study on Differences in COVID-19 Fatality among Wuhan, Rest of Hubei, and Rest of China.

BACKGROUND: China's vigorous anti-COVID-19 campaign has been going on for three months since January 20, which has contained the spread of the virus across China. OBJECTIVES: Epidemiological investigations found that COVID-19 fatality rates in Wuhan, rest parts of Hubei province except Wuhan (Rest of Hubei) and rest parts of Mainland China except Hubei province (Rest of China) were different. An ecological study was conducted to analyze the reasons and provide the world with China's anti-COVID-19 epidemic experiences. METHODS: Infected cases from Mainland China were divided into three populations: Wuhan, Rest of Hubei and Rest of China. Methods were based on The Novel Coronavirus Infected Pneumonia Diagnosis and Treatment Standards. Total confirmed cases, daily severe cases, total deaths from February 12 to April 20 were collected for statistical analysis. RESULTS: 50,333 total confirmed cases in Wuhan made up the most substantial part by comparison with 17,795 in Rest of Hubei and 14,630 in Rest of China, respectively. In the early stage of the COVID-19 epidemic, daily severe cases in Wuhan accounted for the majority, and as the epidemic controlled, severe cases in all three populations decreased. Total deaths in Wuhan constituted the most significant proportion, with the highest 3869 in contrast to 643 in Rest of Hubei and 120 in Rest of China. The fatality rates in Wuhan ranged from 2.82% to 7.69%, much higher than 1.80-3.61% in Rest of Hubei, and 0.49-0.88% in Rest of China. Pearson chi-square test for fatality rates in the three populations demonstrated significant differences (p < 0.01). CONCLUSION: The ecological comparison study among the three populations have proved that social distancing, quarantine, lockdown, cutting off sources of infection and transmission routes, early detection, early isolation, early treatment are all vital to control the epidemic by reducing COVID-19 confirmed cases, severe cases and the fatality rate.

[The update of the limits for low risk alcohol consumption. An opportunity for implementing strategies for early intervention and brief interventions in Spain.] / La actualización de los límites de bajo riesgo del alcohol. Una oportunidad para mejorar la implementación de las estrategias de identificación precoz e intervención breve en España.

This work places in context Spain's recent update of the defined limits for low risk alcohol consumption to 20g/day for men and 10g/day for women, and summarises data on the impact on individual health and the social costs of alcohol consumption. Furthermore, it considers the challenges that arise related to awareness of the risks of alcohol consumption, in the general population and among health professionals. The paper also reviews the implications of the new definitions in relation to the most effective policies for reducing alcohol-related harm. It looks at this from a public health perspective with particular emphasis on how to seize the opportunity to better promote the implementation of strategies for early identification and brief interventions in primary care in this country.

Este trabajo pone en contexto la reciente actualización para España de los limites de bajo riesgo del consumo de alcohol, que se sitúa en los 20 g/día en el caso de los hombres, y en 10 g/día en el caso de las mujeres. En este sentido, se resumen algunos datos sobre el impacto en la salud individual y los costos sociales del consumo alcohol. Así mismo, plantea los retos que se derivan en relación a la alfabetización en salud de la población y de los profesionales de la salud en cuanto a los riesgos del consumo de alcohol. El artículo también repasa las implicaciones de la nueva definición en cuanto a las políticas más rentables para disminuir los daños asociados al consumo de alcohol. Este repaso se hace desde una perspectiva de salud pública, haciendo especial hincapié en cómo aprovechar la oportunidad para promover mejor la implementación de las estrategias de identificación precoz e intervención breve en el consumo de alcohol en el ámbito de la atención primaria de salud en nuestro país.

Thinking about parents and infants - finding a home for perinatal and infant psychiatry.

OBJECTIVES: To describe current issues facing the field of perinatal and infant psychiatry, the issues involved in developing service models and greater awareness of the area in mental health service strategic development. To describe contemporary approaches working to integrate perinatal and infant models with a focus on early-in-life intervention and prevention. CONCLUSIONS: Perinatal and infant psychiatry has ongoing issues in clarifying the location of services and their models of care with a lack of clear higher level governance. It remains a vital area for improving the mental health of both carers and infants and child development.

Early Follow-up After Colorectal Surgery Reduces Postdischarge Emergency Department Visits.

BACKGROUND: Thirty-day readmissions, emergency department visits, and observation stays are common after colorectal surgery (9%-25%, 8%-12%, and 3%-5%), yet it is unknown to what extent planned postdischarge care can decrease the frequency of emergency department visits. OBJECTIVE: This study's aim was to determine whether early follow-up with the surgical team reduces 30-day emergency department visits. DESIGN: This retrospective cohort study used a central data repository of clinical and administrative data for 2013 through 2018. SETTING: This study was conducted in a large statewide health care system (10 affiliated hospitals, >300 practices). PATIENTS: All adult patients undergoing colorectal surgery were included unless they had a length of stay <1 day or died during the index hospitalization. INTERVENTION: Early (<10 days after discharge) versus late (≥10 days) follow-up at the outpatient surgery clinic, or no outpatient surgery clinic follow-up, was assessed. MAIN OUTCOME MEASURES: The primary outcome measured was the time to 30-day postdischarge emergency department visit. RESULTS: Our cohort included 3442 patients undergoing colorectal surgery; 38% of patients had an early clinic visit. Overall, 11% had an emergency department encounter between 11 and 30 days after discharge. Those with early follow-up had decreased emergency department encounters (adjusted HR 0.13; 95% CI, 0.08-0.22). An early clinic visit within 10 days, compared to 14 days, prevented an additional 142 emergency department encounters. Nationwide, this could potentially prevent 8433 unplanned visits each year with an estimated cost savings of $49 million annually. LIMITATIONS: We used retrospective data and were unable to assess for health care utilization outside our health system. CONCLUSIONS: Early follow-up within 10 days of adult colorectal surgery is associated with decreased subsequent emergency department encounters. See Video Abstract at http://links.lww.com/DCR/B330. EL SEGUIMIENTO TEMPRANO DESPUÉS DE LA CIRUGÍA COLORRECTAL REDUCE LAS VISITAS AL SERVICIO DE URGENCIAS POSTERIOR AL ALTA: Los readmisión a los treinta días, las visitas al servicio de urgencias y las estancias de observación son comunes después de la cirugía colorrectal, 9-25%, 8-12% y 3-5%, respectivamente. Sin embargo, se desconoce en qué medida la atención planificada posterior al alta puede disminuir la frecuencia de las visitas al servicio de urgencias.Determinar si el seguimiento temprano con el equipo quirúrgico reduce las visitas a 30 días al servicio de urgencias.Este estudio de cohorte retrospectivo utilizó un depósito central de datos clínicos y administrativos para 2013-2018.Gran sistema de salud estatal (10 hospitales afiliados,> 300 consultorios).Se incluyeron todos los pacientes adultos de cirugía colorrectal a menos que tuvieran una estadía <1 día o murieran durante el índice de hospitalización.Temprano (<10 días después del alta) versus tardío (≥10 días) o sin seguimiento en la clínica de cirugía ambulatoria.Tiempo para la visita al servicio de urgencias a 30 días después del alta.Nuestra cohorte incluyó 3.442 pacientes de cirugía colorrectal; El 38% de los pacientes tuvieron una visita temprana a clínica. En total, el 11% tuvo un encuentro con el servicio de urgencias entre 11 y 30 días después de ser dado de alta. Aquellos con seguimiento temprano disminuyeron las visitas al servicio de urgencias (HR 0,13; IC del 95%: 0,08 a 0,22). Además, una visita temprana a la clínica en un plazo de 10 días, en comparación con 14 días, evitó 142 encuentros adicionales en el servicio de urgencias. A nivel nacional, esto podría prevenir 8.433 visitas no planificadas cada año con un ahorro estimado de $ 49 millones anuales.Utilizamos datos retrospectivos y no pudimos evaluar la utilización de la atención médica fuera de nuestro sistema de salud.El seguimiento temprano dentro de los 10 días de la cirugía colorrectal en adultos se asocia con una disminución de los encuentros posteriores en el servicio de urgencias. Consulte Video Resumen en http://links.lww.com/DCR/B330. (Traducción-Dr. Gonzalo Hagerman).

Dos años de implementacion del EIPP (Equipo de Intervención Precoz en Psicosis) del hospital universitario mutua de terrassa / No disponible

En el año 2017, el Plan director de Salud Mental y Adicciones de Catalunya, puso en marcha el Programa PAE-TPI (Programa de Atención Específica al Trastorno Psicótico Incipiente) después de unos años de corroborar la eficacia de los programas pilotos implementados desde el año 2007 en el territorio catalán. Este programa, es la propuesta de un método organizativo y de un proceso activo de gestión de la psicosis focalizada en la comunidad. Se basa en la detección precoz y la atención individualizada en la que, el vínculo, es uno de los puntos fuertes. Este artículo recoge la puesta en marcha y la preparación previa así como el tipo de intervención propuesta y realizada. También se aportarán datos descriptivos derivados del primer año de asistencia clínica. El programa abarca el área geográfica de Terrassa y Sant Cugat del Vallés

In 2017, the Master Plan for Mental Health and Addictions of Catalonia, launched the PAE-TPI Program (Program for Specific Attention to Incipient Psychotic Disorder) after a few years of corroborating the effectiveness of the pilot programs implemented since 2007 in the Catalan territory. This program is the proposal of an organizational method and a process active management of community-focused psychosis. Is based on the early detection and individualized attention in which the reliance is one of the strengths. This article includes the start-up and previous preparation as well as the type of intervention proposed and carried out. Descriptive data derived from the first year of clinical care will also be provided. The program covers the geographical area of Terrassa and Sant Cugat del Vallés

Desarrollo del programa de atención específica al trastorno psicótico incipiente en Benito Menni Casm / No disponible

La atención a las personas que han desarrollado o pueden llegar a desarrollar una psicosis incipiente debe realizarse de forma precoz. Por ello, la detección es el paso fundamental, seguida del diagnóstico, tratamiento y recuperación de la persona. Todas estas intervenciones transversales son realizadas por diferentes profesionales sanitarios y no sanitarios ubicados en dispositivos diferentes y de entidades proveedoras dispares, lo cual requiere la creación de alianzas y trabajo en red bajo el paraguas de una Unidad Funcional que permita situar a la persona en el centro para que pueda recibir la atención más necesaria en cada momento siguiendo su proyecto vital. Dicha Unidad Funcional debe ser territorial, transversal y comunitaria. En este artículo mostramos el proceso que se ha seguido en la creación de las unidades funcionales del Programa de Atención Específica al Trastorno Psicótico Incipiente (PAE- TPI), así como las comisiones de seguimiento y los resultados preliminares para cada uno de los sectores de referencia de Benito Menni CASM (L'Hospitalet, Sant Boi y Vallès Oriental)

Attention to people who have developed or may develop an incipient psychosis should be done early. Therefore, detection is the fundamental step, followed by diagnosis, treatment and recovery of the person. All these cross-cutting interventions are carried out by different health and non-health professionals, who work in different services and from different providers. The creation of a Functional Unit have two main aims: to reach a professional networking as well as to offer a personalized intervention and a long term monitoring to the target patients of the program. This Functional Unit must be territorial, transversal and community based. In this article we show the process that has been followed in order to create the functional units and the monitoring work commissions of the "Program of Specific Attention to the Incipient Psychotic Disorder", as well as inform about the preliminary results of the three reference population areas assisted by Benito Menni CASM (L'Hospitalet, Sant Boi and Vallès Oriental)

Equipo de intervención precoz en la prevención de psicosis del Parc Taulí (TEIP 3): una visión personal de las dificultades, estado actual y retos futuros sobre la implementación de un programa dirigido a la atención de trastornos psicóticos incipientes / No disponible

Los Programas de Primeros Episodios Psicóticos (PEP), también conocidos como Programas de Atención Específica al Trastorno Psicótico Incipiente (PAE-TPI), se han implementado en diferentes países con la intención de realizar una intervención precoz de pacientes con un primer episodio psicótico o en riesgo de desarrollar una psicosis. En este documento se realiza un visión personal de la implementación de un equipo multidisciplinar para implementar el PAE-TPI del Parc Taulí (Sabadell), que contó con una primera fase sin financiación específica (2015-2017) que consistió en una reorganización de recursos humanos, seguido de una segunda fase con financiación (2018 en adelante) que permitió disponer de un equipo con una mayor dotación con profesionales a dedicación exclusiva. La implementación de una atención específica en el Parc Taulí permitió objetivar una mejoría en variables clínicas respecto a la atención estándar: reducción de la duración de la psicosis no tratada (DUP), menor necesidad de ingreso al inicio de la enfermedad, uso de menores dosis de antipsicótico y una mejoría de la recuperación funcional. Finalmente se realiza una reflexión personal sobre los retos y perspectivas de futuro de los Programas PAE-TPI

First episode psychosis (FEP) program mes have been implemented in diffe rent countries. They address the early intervention of patients with a FEP or at risk of developing psychosis. This docu ment provides a personal view of the im plementation of a multidisciplinary team that developed the FEP programme of Parc Taulí (Sabadell), which had a first sta ge without specific funding (2015-2017) that consisted of a reorganization of hu man resources, followed by a second stage with specific funding (2018 onwards) that allowed to have a team with a greater dedi cation of professionals involved in the pro gramme. The implementation of a specific care at the Parc Taulí allowed to objectify an improvement in clinical variables when compared to standard care: reduction of the duration of untreated psychosis (DUP), less need for admission at the onset of the di sease, use of lower doses of antipsychotic drugs and an improvement of functional recovery. Finally, a personal view is carried out on the challenges and future directions of FEP Programmes

Psicoterapia multifamiliar en la psicosis incipiente: un enfoque interdisciplinar y comunitario / No disponible

La psicoterapia multifamiliar es un modelo de terapia grupal compleja, rica e integradora, que permite incluir en un mismo lugar a pacientes, familias y equipo terapéutico. Las primeras experiencias en grupos multifamiliares se inician en Estados Unidos durante los años cincuenta, en entornos hospitalarios, para el tratamiento de los trastornos psicóticos como la esquizofrenia. Con el tiempo, el modelo multifamiliar se expande por el mundo y se ha venido implementando en distintos dispositivos asistenciales como hospitales de día o programas comunitarios, así como en una gran diversidad de poblaciones clínicas. En febrero de 2018, en el Equipo de Intervención Precoz en Psicosis (EIPP) del área del Baix Empordà, de la red de salud mental pública de la provincia de Girona, se crea un Grupo Multifamiliar (GMF) para jóvenes que han sufrido un Primer Episodio Psicótico (PEP) o bien tienen riesgo de padecerlo, los llamados Estados Mentales de Alto Riesgo (EMAR). En el equipo se construye un escenario terapéutico grupal con el objetivo de vincular, contener y dar continuidad de tratamiento al paciente y a su familia. Nuestro enfoque multifamiliar se ha inspirado en las ideas de Jaakko Seikkula y su modelo psicoterapéutico de Diálogo Abierto (Open Dialogue), y en las aportaciones de Irvin Yalom sobre la eficacia de los Factores Terapéuticos Grupales. Hemos hecho especial hincapié en los elementos a tener en cuenta en la gestión del clima emocional del grupo, que como sabemos es una de las variables de cambio psíquico más importantes. Nuestro GMF tiene como característica particular, la conducción terapéutica interdisciplinar. El presente artículo muestra el proceso de implementación e integración del GMF en un programa comunitario de intervención precoz de los trastornos psicóticos incipientes

Multifamily psychotherapy is a complex, rich and inclusive group therapy model that allows patients, families and a therapeutic team to be included in the same place. The first experiences in multi-family groups began in the United States during the 1950s, in hospital settings, for the treatment of psychotic disorders such as schizophrenia. Over time, the multi-family model has been spread throughout the world and has been implemented in different healthcare services such as day hospitals or community programs as well as in a wide variety of clinical populations. In February 2018, in the Early Intervention Team in Psychosis (EIPP) of the Baix Empordà area, of the public mental health network of the province of Girona, a Multifamily Group (MFG) is created for young people who have suffered from a First Psychotic Episode (FPE) or they are at risk of suffering it, the so-called High Risk Mental States (HRMS). The team builds a group therapeutic scenario with the aim of linking, controlling and giving continuity of treatment to the patient and their family. Our multifamily approach has been inspired by Jaakko Seikkula's ideas and his Open Dialogue psychotherapeutic model, and by the contributions of Irvin Yalom on the efficacy of Group Therapeutic Factors. We have placed special emphasis on the elements to be taken into account when managing the emotional climate of the group, which is known as one of the most important variables of psychic change. Our GMF has as its particular characteristic, Interdisciplinary Therapeutic Management. This article shows the process of implementation and integration of the GMF in an incipient psychotic disorders early intervention community program

The development of the Early Intervention in Psychosis (EIP) outpatient unit of Eginition University Hospital into an EIP Network.

Over the past 25 years, in the field of psychosis there is an increased interest in early detection of symptoms and treatment provision for people who are either at Ultra High Risk (UHR) of developing psychosis or with First Episode Psychosis (FEP). Extensive research has proved, that by engaging quickly into treatment and addressing the needs of each case individually, clinical outcomes could be improved substantially. The above evidence-based argument has resulted in the establishment of specialized Early Intervention in Psychosis (EIP) services worldwide. Eginition University Hospital (EUH) in Athens has been providing care for Early Psychosis through a specialized outpatient EIP service since 2012, which receives all early psychosis cases. Initially clinical focus was mainly directed towards UHR cases, since EUH had long been providing standard care for FEP. However, over the last 4 years, the EIP Unit has evolved incrementally into a network of directly linked services, involving the EIP outpatient service, an Inpatient Unit for prompt hospitalization and a Day Clinic for partial hospitalization, to address acute treatment, follow-up and recovery/relapse prevention phases. Diagnostic evaluation is made through specialized instruments along with the typical psychiatric interview. The therapeutic approach follows the international guidelines for EIP, namely symptom-based and phase-specific treatment, which includes supportive counselling, coping strategies and psychoeducation both for subjects and family members, as well as pharmacotherapy when needed and preferably in low doses. Regarding our results, in the first 3 years (3/2012-3/2015) the EIP unit received 26 (60%) UHR subjects and 17 (40%) FEP patients. Over the last 4 years (3/2015-3/2019) the referrals rose to 167 with 35 (21%) UHR and 132 (79%) FEP cases. All of the UHR subjects were from the outset followed by the specialized outpatient EIP service for up to 3 years. As to the FEP patients, seventy-seven (60%) were acutely hospitalized for less than a month, and 10 (8%) attended the Day Clinic for 6 - 12 months, before being referred to the outpatient service. Concluding, the development of the EIP network of specialized services has cohesively enabled a broader therapeutic framework, shifting the clinical focus towards FEP, although UHR subjects are still being assessed systematically. However, there is still considerable work to be done, in order to enhance the full potential of all units and promote the interconnection with potential community settings.

Health professionals' perspectives on delivering home and hospital management at diagnosis for children with type 1 diabetes: A qualitative study from the Delivering Early Care in Diabetes Evaluation trial.

OBJECTIVE: To explore the delivery of home and hospital management at diagnosis of type 1 diabetes in childhood and any impact this had on health professionals delivering care. METHODS: This qualitative study was undertaken as part of the Delivering Early Care in Diabetes Evaluation randomized controlled trial where participants were individually randomized to receive initiation of management at diagnosis, to home or hospital. Semi-structured telephone interviews were planned with a purposive sample of health professionals involved with the delivery of home and hospital management, to include consultants, diabetes and research nurses, and dieticians from the eight UK centres taking part. The interview schedule focused on their experiences of delivering the two models of care; preferences, impact, and future plans. Data were subject to thematic analysis. RESULTS: Twenty-two health professionals participated, represented by consultants, diabetes and research nurses, and dieticians. Overall, nurses preferred home management and perceived it to be beneficial in terms of facilitating a unique opportunity to understand family life and provide education to extended family members. Nurses described a special bond and lasting relationship that they developed with the home managed children and families. Consultants expressed concern that it jeopardized their relationship with families. Dieticians reported being unable to deliver short bursts of education to families in the home managed arm. All health professionals were equally divided over which was logistically easier to deliver. CONCLUSIONS: A hybrid approach, of a brief stay in hospital and early home management, offers a pragmatic solution to the advantages and challenges presented by both systems.

Development of an early intervention programme for adolescents with emotion dysregulation and their families: Actions for the treatment of adolescent personality (ATraPA).

AIM: Borderline personality disorder and severe emotion dysregulation in adolescence is a major public health concern. Dialectical Behaviour Therapy is a promising treatment for suicidality in adolescents. The aim of this work is to present an adaptation of this intervention to the Spanish national health system, Actions for the Treatment of Adolescent Personality (ATraPA). METHOD: Data consists of a description of the different ATraPA subprogrammes, including interventions for adolescents aged 13 to 17 and their families. Participants were referred to ATraPA from different hospitals within the region of Madrid, Spain. RESULTS: ATraPA has been developed as an intensive outpatient treatment and it comprises different subprogrammes. ATraPA-TAI is an intensive outpatient treatment, including a skills-based group, individual therapy and email therapy. ATraPA-FAL is a psychoeducational intervention for families, including emotion regulation strategies for parents themselves. Finally, the Alternatives Group is offered to adolescents during the hospital admission, with the aim of promoting alternative coping skills. The group of therapists provides a support network to the professionals involved in ATraPA. CONCLUSIONS: ATraPA has been successfully implemented in a Child and Adolescent Psychiatry Service within the Spanish national health system. Future studies should address the efficacy of ATraPA using a controlled design.

Où en sommes-nous? An Overview of Successes and Challenges after 30 Years of Early Intervention Services for Psychosis in Quebec: Où en sommes-nous? Un aperçu des réussites et des problèmes après 30 ans de services d'intervention précoce pour la psychose au Québec.

INTRODUCTION: Over the last 30 years, early intervention services (EIS) for first-episode psychosis (FEP) were gradually implemented in the province of Quebec. Such implementation occurred without provincial standards/guidelines and policy commitment to EIS until 2017. Although the literature highlights essential elements for EIS, studies conducted elsewhere reveal that important EIS components are often missing. No thorough review of Quebec EIS practices has ever been conducted, a gap we sought to address. METHODS: Adopting a cross-sectional descriptive study design, an online survey was distributed to 18 EIS that existed in Quebec in 2016 to collect data on clinical, administrative, training, and research variables. Survey responses were compared with existing EIS service delivery recommendations. RESULTS: Half of Quebec's population had access to EIS, with some regions having no programs. Most programs adhered to essential components of EIS. However, divergence from expert recommendations occurred with respect to variables such as open referral processes and patient-clinician ratio. Nonurban EIS encountered additional challenges related to their geography and lower population densities, which impacted their team size/composition and intensity of follow-up. CONCLUSIONS: Most Quebec EIS offer adequate services but lack resources and organizational support to adhere to some core components. Recently, the provincial government has created EIS guidelines, invested in the development of new programs and offered implementation support from the National Centre of Excellence in Mental Health. These changes, along with continued mentoring and networking of clinicians and researchers, can help all Quebec EIS to attain and maintain recommended quality standards.

Determinants of pathways to care among young adults with early psychosis entering a coordinated specialty care program.

AIM: To describe the characteristics of the pathway to coordinated specialty care for young adults with early psychosis in the United States, to examine how various factors correlate with the duration of untreated psychosis (DUP), and to explore factors associated with time from onset of symptoms to first mental health service contact (help-seeking DUP). METHODS: The sample included 779 individuals ages 16 to 30 with recent-onset non-affective psychosis enrolled in OnTrackNY. Domains assessed included demographics, clinical characteristics, mental health service utilization and characteristics of the pathway to care. Primary outcomes included the time from onset of psychotic symptoms to admission to OnTrackNY (DUP) and time from onset of psychotic symptoms to first mental health service contact (help-seeking DUP). RESULTS: The mean DUP was 231.2 days (SD = 87.7, median = 169) and mean help-seeking DUP was 73.7 days (SD = 110.8, median = 27). Being in school, better social functioning, and greater number of ER visits or hospitalizations were associated with shorter DUP. Violent ideation or behaviour and having an outpatient mental health visit as the first service contact or hallucinations as the reason for first service contact were significantly associated with longer DUP. Only the type of first service contact (outpatient mental health treatment or other non-mental health service provider) and having hallucinations as the clinical reason for the first service contact were associated with help-seeking DUP. CONCLUSIONS: Referral delays were longer than help-seeking delays. Strategies to reduce treatment referral delays through systems-level interventions may be most likely to reduce the overall DUP in this population.

La actualización de los límites de bajo riesgo del alcohol. Una oportunidad para mejorar la implementación de las estrategias de identificación precoz e intervención breve en España / The update of the limits for low risk alcohol consumption. An opportunity for implementing strategies for early intervention and brief interventions in Spain

Este trabajo pone en contexto la reciente actualización para España de los limites de bajo riesgo del consumo de alcohol, que se sitúa en los 20 g/día en el caso de los hombres, y en 10 g/día en el caso de las mujeres. En este sentido, se resumen algunos datos sobre el impacto en la salud individual y los costos sociales del consumo alcohol. Así mismo, plantea los retos que se derivan en relación a la alfabetización en salud de la población y de los profesionales de la salud en cuanto a los riesgos del consumo de alcohol. El artículo también repasa las implicaciones de la nueva definición en cuanto a las políticas más rentables para disminuir los daños asociados al consumo de alcohol. Este repaso se hace desde una perspectiva de salud pública, haciendo especial hincapié en cómo aprovechar la oportunidad para promover mejor la implementación de las estrategias de identificación precoz e intervención breve en el consumo de alcohol en el ámbito de la atención primaria de salud en nuestro país

This work places in context Spain's recent update of the defined limits for low risk alcohol consumption to 20g/day for men and 10g/day for women, and summarises data on the impact on individual health and the social costs of alcohol consumption. Furthermore, it considers the challenges that arise related to awareness of the risks of alcohol consumption, in the general population and among health professionals. The paper also reviews the implications of the new definitions in relation to the most effective policies for reducing alcohol-related harm. It looks at this from a public health perspective with particular emphasis on how to seize the opportunity to better promote the implementation of strategies for early identification and brief interventions in primary care in this country