Patient Attitudes Toward Telepsychiatry During the COVID-19 Pandemic: A Nationwide, Multisite Survey.

Background The COVID-19 pandemic and its associated movement restrictions forced a rapid and massive transition to telepsychiatry to successfully maintain care continuity. Objective The aim of this study is to examine a large number of patients\u27 experiences of, use of, and attitudes toward telepsychiatry. Methods An anonymous 11-question survey was delivered electronically to 14,000 patients receiving telepsychiatry care at 18 participating centers across 11 US states between the months of April and June 2020, including questions about their age and length of service use, as well as experience and satisfaction with telepsychiatry on a 5-point Likert scale. Descriptive statistics were used to analyze and report data. Results In total, 3070 patients with different age ranges participated. The overall experience using telepsychiatry was either excellent or good for 1189 (82.2%) participants using video and 2312 (81.5%) using telephone. In addition, 1922 (63.6%) patients either agreed or strongly agreed that remote treatment sessions (telephone or video) have been just as helpful as in-person treatment. Lack of commute (n=1406, 46.1%) and flexible scheduling/rescheduling (n=1389, 45.5%) were frequently reported advantages of telepsychiatry, whereas missing the clinic/hospital (n=936, 30.7%) and not feeling as connected to their doctor/nurse/therapist (n=752, 24.6%) were the most frequently reported challenges. After the current pandemic resolves, 1937 (64.2%) respondents either agreed or strongly agreed that they would consider using remote treatment sessions in the future. Conclusions Telepsychiatry is very well perceived among a large sample of patients. After the current pandemic resolves, some patients may benefit from continued telepsychiatry, but longitudinal studies are needed to assess impact on clinical outcomes and determine whether patients\u27 perceptions change over time

What is the duration of untreated psychosis worldwide? - A meta-analysis of pooled mean and median time and regional trends and other correlates across 369 studies.

Duration of untreated psychosis (DUP) has been associated with poor mental health outcomes. We aimed to meta-analytically estimate the mean and median DUP worldwide, evaluating also the influence of several moderating factors. This PRISMA/MOOSE-compliant meta-analysis searched for non-overlapping individual studies from inception until 9/12/2022, reporting mean ± s.d. or median DUP in patients with first episode psychosis (FEP), without language restrictions. We conducted random-effect meta-analyses, stratified analyses, heterogeneity analyses, meta-regression analyses, and quality assessment (PROSPERO:CRD42020163640). From 12 461 citations, 369 studies were included. The mean DUP was 42.6 weeks (95% confidence interval (CI) 40.6-44.6, k = 283, n = 41 320), varying significantly across continents (p < 0.001). DUP was (in descending order) 70.0 weeks (95% CI 51.6-88.4, k = 11, n = 1508) in Africa; 48.8 weeks (95% CI 43.8-53.9, k = 73, n = 12 223) in Asia; 48.7 weeks (95% CI 43.0-54.4, k = 36, n = 5838) in North America; 38.6 weeks (95% CI 36.0-41.3, k = 145, n = 19 389) in Europe; 34.9 weeks (95% CI 23.0-46.9, k = 11, n = 1159) in South America and 28.0 weeks (95% CI 20.9-35.0, k = 6, n = 1203) in Australasia. There were differences depending on the income of countries: DUP was 48.4 weeks (95% CI 43.0-48.4, k = 58, n = 5635) in middle-low income countries and 41.2 weeks (95% CI 39.0-43.4, k = 222, n = 35 685) in high income countries. Longer DUP was significantly associated with older age (β = 0.836, p < 0.001), older publication year (β = 0.404, p = 0.038) and higher proportion of non-White FEP patients (β = 0.232, p < 0.001). Median DUP was 14 weeks (Interquartile range = 8.8-28.0, k = 206, n = 37 215). In conclusion, DUP is high throughout the world, with marked variation. Efforts to identify and intervene sooner in patients with FEP, and to promote global mental health and access to early intervention services (EIS) are critical, especially in developing countries

Changes in Telepsychiatry Regulations during the COVID-19 Pandemic: 17 Countries and Regions' Approaches to an Evolving Healthcare Landscape

Background: During the COVID-19 pandemic, the use of telemedicine as a way to reduce COVID-19 infections was noted and consequently deregulated. However, the degree of telemedicine regulation varies from country to country, which may alter the widespread use of telemediine. This study aimed to clarify the telepsychiatry regulations for each collaborating country/region before and during the COVID-19 pandemic. Methods: We used snowball sampling within a global network of international telepsychiatry experts. Thirty collaborators from 17 different countries/regions responded to a questionnaire on barriers to the use and implementation of telepsychiatric care, including policy factors such as regulations and reimbursement at the end of 2019 and as of May 2020. Results: Thirteen of 17 regions reported a relaxation of regulations due to the pandemic; consequently, all regions surveyed stated that telepsychiatry was now possible within their public healthcare systems. In some regions, restrictions on prescription medications allowed via telepsychiatry were eased, but in 11 of the 17 regions, there were still restrictions on prescribing medications via telepsychiatry. Lower insurance reimbursement amounts for telepsychiatry consultations versus in-person consultations were reevaluated in 4 regions, and consequently, in 15 regions telepsychiatry services were reimbursed at the same rate (or higher) than in-person consultations during the COVID-19 pandemic. Conclusions: Our results confirm that, due to COVID-19, the majority of countries surveyed are altering telemedicine regulations that had previously restricted the spread of telemedicine. These findings provide information that could guide future policy and regulatory decisions, that facilitate greater scale and spread of telepsychiatry globally

Pathways towards a sustainable future envisioned by early-career conservation researchers

Scientists have warned decision-makers about the severe consequences of the global environmental crisis since the 1970s. Yet ecological degradation continues and little has been done to address climate change. We investigated early-career conservation researchers' (ECR) perspectives on, and prioritization of, actions furthering sustainability. We conducted a survey (n = 67) and an interactive workshop (n = 35) for ECR attendees of the 5th European Congress of Conservation Biology (2018). Building on these data and discussions, we identified ongoing and forthcoming advances in conservation science. These include increased transdisciplinarity, science communication, advocacy in conservation, and adoption of a transformation-oriented social-ecological systems approach to research. The respondents and participants had diverse perspectives on how to achieve sustainability. Reformist actions were emphasized as paving the way for more radical changes in the economic system and societal values linked to the environment and inequality. Our findings suggest that achieving sustainability requires a strategy that (1) incorporates the multiplicity of people's views, (2) places a greater value on nature, and (3) encourages systemic transformation across political, social, educational, and economic realms on multiple levels. We introduce a framework for ECRs to inspire their research and practice within conservation science to achieve real change in protecting biological diversity

Use of Behavioral Economics to Improve Medication Adherence in Severe Mental Illness.

Medication nonadherence is associated with multiple negative outcomes. Financial reinforcement based on behavioral economic principles has been proposed as a potential strategy to enhance medication adherence in severe mental illness, and some studies show that small incentives significantly increase adherence to long-acting injectable treatment. After the intervention is stopped, however, adherence appears to decline. Because of the limited number of studies published so far, results should be interpreted with caution. When implementing this strategy, measures must be taken to address ethical concerns. Larger, naturalistic studies focusing on the effects of financial incentives for different treatment formulations are needed to further evaluate this adherence-enhancing strategy

La pérdida de biodiversidad por abandono rural en el LTER Montseny cuantificada a partir del monitoreo de aves

El abandono de las prácticas agro-ganaderas tradicionales en las áreas montañosas de la cuenca mediterránea está a menudo asociado a un incremento general de la masa vegetal y a una pérdida de ambientes abiertos. Los espacios protegidos de montaña de la red LTER (Long Term Ecological Research) son zonas privilegiadas para estudiar en detalle este proceso mediante proyectos de seguimiento de las poblaciones a largo plazo. En el caso particular del nódulo LTER-Montseny el impacto de la reforestación en las aves está siendo monitoreado gracias a la implantación, hace ya más de una década, del programa de seguimiento de aves comunes en Cataluña. Este programa de seguimiento está permitiendo desarrollar indicadores que determinan la evolución de las comunidades de aves de medios abiertos y de los bosques de este parque natural. En este trabajo se emplean indicadores multiespecíficos basados en la media geométrica de índices poblacionales anuales para determinar los cambios están sufriendo las aves de estos ambientes. Los resultados muestran que en el periodo 2002-2014 el impacto de la reforestación está siendo notable para las poblaciones de aves de medios abiertos (decremento poblacional del 44% entre 2002 y 2014). En consonancia con estos resultados, los gestores del parque han impulsado medidas de recuperación de los pastizales del parque conjuntamente con los agentes socieconómicos locales

Topological magnetic irreversibility in superconducting Pb samples of various shapes

The magnetic-field dependence of the magnetization of cylinders, disks, and spheres of pure type-I superconducting lead was investigated by means of isothermal measurements of first magnetization curves and hysteresis cycles. Depending on the geometry of the sample and the direction and intensity of the applied magnetic field, the intermediate state exhibits different irreversible features that become particularly highlighted in minor hysteresis cycles. The irreversibility is noticeably observed in cylinders and disks only when the magnetic field is parallel to the axis of revolution and is very subtle in spheres. When the magnetic field decreases from the normal state, the irreversibility appears at a temperature-dependent value whose distance to the thermodynamic critical field depends on the sample geometry. The irreversible features in the disks are altered when they are submitted to an annealing process. These results agree well with very recent high-resolution magneto-optical experiments in similar materials that were interpreted in terms of transitions between different topological structures for the flux configuration in the intermediate state. A discussion of the relative role of geometrical barriers for flux entry and exit and pinning effects as responsible for the magnetic irreversibility is given