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The Oldham family has been in the involved in the building construction business in Queensland for over 30 years.
Meet our team
Connor Oldham
Construction Manager
8 years in the industry. Qualified as a Carpenter, Connor is experienced in frames, fix outs, cladding, roofing, fencing, decking, plastering and concreting.
Connor also specialises in estimating and administration of contracts for customers. He will be the person that will deal with local authorities and Phoenix Homes Queensland partner companies to ensure the work is of the highest quality standard.
Connor is currently active in car rallying driving a Mazda 323 Familia 4WD. Recently he managed 2nd in the 2018 P3 Solutions Queensland Clubman Rally Series.
Contact Connor on email@example.com
Alex Beazley
Construction Manager
8 years in the industry. Qualified as a Carpenter, Alex is experience in frames, fix outs, cladding, roofing, fencing, decking, plastering and concreting.
Spent 3 years in high rise commercial sheet fixing. Spent apprenticeship doing renovations, insurance work and shopping centre maintenance most of my time has been in the country before moving to the Gold Coast 3.5 years ago.
In his spare time, Alex spends competitive free diving and enjoys 4WD driving.
Contact Alex on firstname.lastname@example.com
Darcy Oldham
General Manager
Confident, hardworking and motivated, Darcy has accumulated over 30 years working within the residential building industry.
Darcy has key skills in:
- Construction Project Management – Specialising in Residential and Light Commercial Building and Construction
- Queensland Licensed Builder – Low rise
- Veritable track record for the successful completion of projects through coordinating trades, developing partnerships, building rapport with architects, engineers, local officials, vendors and clients whilst maintaining effective costs.
- Versed in all areas of residential building construction, including; contract negotiations, project estimating, overcoming impending design problems, document preparation, building code and regulations, material purchasing, site management and obtaining the certificate of occupancy.
- Posses a 100% Clean Building Record with the QBCC and has clients over a 30 year career.
Karen Oldham BBus
Administration Manager
Karen has had over 30 years experience in accounts and administrative systems in the Building and Construction industry in Queensland. She has also held numerous volunteer treasurer roles within sporting bodies and community groups in Queensland. This resulted in sound accounting practices been put in place.
Karen holds a Bachelor of Business from the University of Southern Queensland.


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Maternal, neonatal and child mortality are still very serious health challenges in Africa despite decades of efforts by governments and other stakeholders to address them. Nigeria has one of the highest maternal and infant mortality rates in the world. In terms of the actual number of maternal deaths, Nigeria is ranked second in the world behind India! Nigeria is part of a group of six countries in 2008 that collectively accounted for over 50% of all maternal deaths globally.
In terms of maternal mortality ratio (MMR), Nigeria is ranked eighth in Sub-Saharan Africa, behind Angola, Chad, Liberia, Niger, Rwanda, Sierra Leone and Somalia. The situation in the Northwest and northeast geopolitical zones is significantly worse than the national average; the MMR is 1,025 per 100,000 live births compared to the national average of 800 per 100,000 live births. The Northwest and Northeastern states continue to lag behind in educational and health indices. According to World Health Organization statistics, these places are some of the worst places to get pregnant and give birth in the world!
With its current fertility rate, tradition of short birth intervals (with very low usage of family planning of course), harmful cultural practices, high rate of poverty and illiteracy, it is no wonder northern Nigeria is a major contributor to the national maternal mortality burden.
Maternal mortality, simply put, is dying while giving birth. The International Classification of Diseases, Injuries and Causes of Death defined maternal death as "the death of a woman within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes."
From this definition, it would seem Nigeria is not only getting it wrong with keeping women alive while giving life, we continue to fail in accurate documentation of death of women who die giving birth. Mostly, only deaths that occur in health facilities and at the point of delivery are reported leaving out thousands more that occur far away among communities most of which are not covered by the basest of health services. This is credence to the fact that we are even yet to fully understand the enormity of the problem let alone find the right solutions to them!
It is on record that lots of resources have been invested to reduce or eradicate maternal mortality in Africa without corresponding results. In Nigeria for instance, the health system is still too weak to respond to the very low demand for skilled health services, and where services are available, people still refuse to use them due to apathy. Stakeholders have attempted to strengthen the health systems to respond adequately to health needs of ordinary Nigerians but nothing seems to be changing despite the length of time and resources expended. Obviously, lots of things are still not being done right. Please, note that reference is made here to the entire health system because nothing can be done to improve maternal/child health in isolation of the entire nexus of health systems.
Despite increasing knowledge on the dangers of doing so, Northern Nigerian women have increasingly sought the services of traditional birth attendants (note: pregnant women are expected to attend at least 3 antenatal sessions before delivery). More women continue to deliver at home – most of which never attend a single antenatal session. Initially, the general view held was that certain barriers were solely responsible for refusal of communities to patronize orthodox health services; however new evidence seems to be diffusing these initially strong views. There are cases where women have blatantly called for services of traditional birth attendants in spite of considerable access to skilled orthodox health care. Evidently, there is more to the initially identified 3 delays of accessing obstetric care among women in northern Nigeria.
Underage marriage is a major driver of maternal morbidity and mortality in northern Nigeria which increases the chances of obstructed birth, due to small pelvic size. Also, alternative use of Traditional Birth Attendants (TBAs) and general delays in seeking professional health care assistance when complications occur add to the problem. There are of course other underlying factors such as cultural views about pregnancy. For example, pregnancy is treated as an extremely private condition, with women being secluded, little discussion on the topic even between individuals who know each other well, and birth delivery being performed at home.
Skill gaps with existing professional health staff, and the disconnect between health policymaking at the federal government level and local government decision-making, accountability and implementation of these policies have led to further complications of the problem. It is therefore laughable that people wonder why women in their right senses still patronize TBAs. Why not? What with the increasing lack of access to and use of skilled attendance at birth even for the few who give birth in health facilities; and a weak healthcare delivery system characterized by too few health facilities and even fewer health professionals? Verified cases of hazardous facility practices have also helped to deter women from using skilled health services. Women literally have no choice but seek services where they know they can get them not minding how crude those services may be.

subset: commoncrawl


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It's romper season and I love a good romper! What about you? They are great for casual wear with flats or dressed up with a nice pair of heels. This particular one (found here) is from AMI Clubwear. Check out their website. They have some awesome summer staples.
I paired the romper with a jean jacket (here) to add a bit of color and a more casual look. Opting for sandals, found here, because I spent this day picking strawberries at Huber's Orchard & Winery with the girls. If you live in Kentucky or Indiana I definitely suggest a family or friend outing to Huber's.
No outfit is complete without jewelry. I definitely get my moneys worth out these earrings and necklace. They are by far my favorite and have been on full rotation since I got them. I finished the outfit with a pair of tortoise shell sunnies (similar here). With warmer weather in sight, rompers will be one of my summer staples. What is your summer staple?
Romper c/o of AMI Clubwear (website)


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As we draw ever closer to The International, teams are hoping to pull out big wins at the final two majors to secure their spot to the premier Dota 2 tournament.
The Disneyland major is the fourth major of the current DPC season. It will be held at the Disney events Arena, located in Disneyland Paris. The first eSport event held at a Disneyland since 2010.
Like the other majors of the season, Disneyland will offer teams their share of $1,000,000 and 15,000 DPC points. The distribution of rewarded DPC remains very top heavy, a 1st place finish at the major would sit 5th on the current DPC ladder. This makes the remaining opportunities to earn points invaluable for teams looking to secure a trip to The International.
The format follows what we have seen at previous majors for the most part. The Group stage starts on the 4th of May at 6pm AEST. It follows GSL Bo3 formatting, with the top 2 from each group advancing to the upper bracket.
Playoffs are from the 6th of May 6pm AEST to the 12th. Its played in a double elimination format with Upper Bracket/Lower Bracket starting positions being determined by the groups. All games are Bo3 except the 1st round of the lower bracker which is Bo1 and the grand final that's Bo5.
The groups for MDL Disneyland
Groups have been seeded by their DPC points. This long-term measurement is bad at predicting short term performances. NIP has been over valued significantly and liquid undervalued which has caused some lopsided groups:
Team Secret It's no secret that Team Secret are the current scene leaders. Posting some of the most consistently dominant performances we've seen internationally for quite some time. This doesn't mean that they're infallible and have been continually thwarted by a back and forth with VP. They're still my favourite coming in for their strategic mastery of the current patches and their consistency in past competitions.
Virtus.Pro After their odd performance at MDL Macau, VP have once again show why you don't mess with a bear. They had an outstanding run in the lower brackets, finishing 2nd at the Dreamleague 11 major. While they haven't looked as dominant as Secret, they have posted better results at majors and are currently number 1 on the DPC rankings. If past results are any indication, expect a top 3 finish from the Russians.
Evil Geniuses NA's finest once again come to bleed blue. The weak placing in Dreamleague could be due to a loaded lower bracket and doesn't tell us much. Much like the other top tier teams, their lack of participation in local competitions means we can only go off their position in the global field. EG should remain top 5 coming into the event, but their weak performances against the likes of Secret, Liquid, their back and forth with VP, means there's a fair chance they meet a road block before the finals. They have been criticised for their static and uninspired strategies, and EG will have to have a major shakeup to compete with the increased competition in the scene.
PSG.LGD LGD is China's tier 1. Coming in a close 2nd place at TI8, LGD has continued to impress, hovering around 4th-6th at every major. After the Chongqing Major, Somnus took a break and concerns came out whether LGD would still be able to hold their spot. While they came 5th-6th at the Dreamleague major, the games they won to get there were against far inferior teams and didn't yield confidence. With the Disneyland major approaching, LGD have announced Somnus's return after his indefinite break. Much like OG, whether his return will bring back the form that saw them as the strongest team coming into the 2018/19 DPC season is yet to be seen.
Fnatic SEAs Tier 1 team has not disappointed this season, stringing together consistent performances internationally. Fnatic has been able to handily beat other scene leaders. Their 3rd place finish at Dreamleague and 5th-6th at the Chongqing major put them at 5th on the DPC ladder. While they have been in the lead group of teams, they're yet to come away with a win and really show that they're the best. I'd expect them to once again finish mid-high while knocking some of the other favourites down a peg.
Team Liquid Liquid are in an odd position. After failing to qualify for the first major, they have posted very weak results at the last two. This puts them barely in TI9 invitations at 12th position. Liquid has been leading the main pack for some time and continue to beat anybody who isn't Secret time and time again. While they still beat the best, consistency has become an issue. With a 1st round exit at Dreamleague major and all series in the qualifiers for Disneyland being 2-1's against some lesser quality teams, Liquid must prove they can go the distance once again.
Vici Gaming VG didn't have many results this season until the last major where they white washed the minor and continued to win the Major, completely shattering expectations. Yet I don't feel like they're a favourite coming in. They showed us the strength of the Chinese scene. But their results coming into this event are nothing special and you don't become an international mainstay from one run. I'd put them in the same tier as Keen, well above other regions tier 2-3 teams, but they might not be able to consistently beat the big dogs.
Keen Gaming Keen as a team never really posted any significant results until the addition of 'Kaka' and two loaned players from EHOME. Since then Keen have struck back, finishing 2nd at the Bucharest Minor, 2nd at WESG, and qualifying for all major events in the tough Chinese scene. The last major really confirmed their strength, as they ended up finishing 5th-6th and beating both EG and Liquid. Their dominance at ESL One Mumbai has established them as well above the other regions tier 2-3 teams. I have high expectations for Keen and would pin them for a mid to high place finish.
OG After winning The International 8, OG fell ill with a severe case of the winner's curse. The performance drop can be attributed to the loss of 'Ana', who spearheaded their playstyle. After not making it to a major in the current season, OG is once again on the international stage after the return of Ana, reforming the TI8 winning squad. Since his return they've had a decent performances in the Disneyland qualifiers, going down to liquid 1-2 and looking more succinct in their playstyle. I'm optimistic for their recovery as a team, but only time will tell if they can retake their position on the podium.
Ninjas in Pyjamas After winning the Dota PIT minor, NiP have taken the last spot in the major. NiP are in an odd spot, not really holding a stable position in the European scene. After high expectations coming into the DPC season, NiP have fallen out of the pack. Recent results show an inability to consistently beat any tier 1-2 teams. While this wasn't an issue in the minor, the major is full of these types of teams and I don't know if NiP can win enough games to progress through the event.
Chaos Esports Club The SA scene has looked weak, with no significant global performances to indicate the region has a strong matchup with the rest of the world. Chaos's last major performances include a joint last at Kuala Lumpar, 9th -12th at the Chongqing, and another 9th -12th at Dreamleague. While I'm normally optimistic for Chaos in global competition, it's difficult with their resent results. Chaos has taken the typical scene leader approach of forgoing local competition for the bigger international fish. They've played in only 3 tournament this year with their best placing being 8th. Team can take games off stronger teams, but lack the endurance and consistency required to beat them in series.
Team Empire An old name in the scene that has been absent internationally for some time. A team that once used to compete with VP, Empire lost a lot of core players to poaching from larger teams. The beginning of the year saw the departure of 'Miposhka' who had captained the team for almost 3 years. This saw the team reform around less know CIS players. This has yielded promising results consistently beating weaker CIS teams. When playing against more experienced European teams they've had fewer comprehensive results, constantly falling to NiP and having mixed results against teams like Alliance. Against the stronger and more consistent teams in the major, it will be interesting to watch how the young squad performs. Until we see this however, we can only expect middle to back of the pack results.
CompLexity Gaming I've talked before about my lack of faith in CompLexity and their inability to properly compete at any sort of premier international event before. Their appearance in Disneyland is more down to external factors in the North American Scene then their own internal performance. They got blitzed at ESL One Mumbai against teams that didn't even manage to qualify for Disneyland. The only thing that could save them is if the recent dropping of 'Deth' for 'Monkey-forever' 2 weeks ago has any positive impact. They haven't played a game as their new squad, so its impossible to predict the effect of this change.
TEAM TEAM The North American scene is currently undergoing some changes with Forwards Gaming and J.Storm no longer getting free rides to majors. TT who have recently rebranded to Beastcoast, have had mixed results coming in. While they managed a strong run to qualify for the Disneyland major, they failed to qualify for ESL Birmingham and had a weak playoff run at Mumbai. Along with this they have controversially gutted their team right before the major, leaving doubt around their ability to perform. I don't really have high expectations for the team, but you never know what EE's capable of.
paiN Gaming The original paiN roster was signed by Chaos esports club. This new iteration formed off the back of the Flying Penguin disband with 'Liposa' coming back to the SA scene. The team immediately found success in the open qualifiers and the major qualifiers dropping only 2 games, including a 2-0 against Chaos Esports. This will be the teams first outing since their signing to paiN gaming. They're a bit of a wild card due to the young team but have had great results locally in South America.


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Brit's Picks Jan. 18 – 25
Stroll Through Culture Thurs. – Sat.
President's Residence (UofS Campus)
It's a chance to celebrate where we have come from and where we are going in this city and how it all relates back to the land. Theatre on the Trail is the latest production from Sum Theatre. It's the troupe known for taking performance out of its regular confines and finding new ground that the whole family can enjoy. This is a show that will take audiences on a walk down the Meewasin Trail as they see brand new artwork and witness uplifting theatre, rap and poetry all created by a group of Indigenous and Newcomer artists. The whole experience takes about 40 minutes and you'll want to make sure you dress for the elements as it's all outside. This show is entirely family friendly and free. The performances happen at 5:00 p.m., 6:00 p.m. and 7:00 p.m. nightly.
Click here for more information.
Musical Prose Friday
Cosmo Seniors Centre
You take a couple of musical talents with theatre inclings, throw in a classic novel and what you get is something that's never been seen before. By Grand Central Station is a song cycle by Royal Canoe frontman Matt Peters and actor/singer-songwriter Tom Keenan who are known as Heavy Bell. The duo has taken the poetry of Elizabeth Smart's work By Grand Central Station I Sat Down and Wept and set her story to music. This is the story of a woman's inner journey and even features a recording of Elizabeth Smart reading passages. This is a show that will push the boundaries of a traditional music show and it's really lovely. Tickets are $22.
Click here for more information.
Double Feature Thurs. – Sat.
The Refinery
In an exciting double bill, audiences will get a chance to see two shows for the price of one. The Broadway Theatre and Sum Theatre have teamed up to bring two groundbreaking shows to the stage. SPIN by Evalyn Parry is a show that celebrates the bicycle as a muse, musical instrument and creator of social change. The second show on tap is In Case We Disappear by Vanessa Smythe. This is a show about love, family and what we leave the people closest to us when we die. This is a show full of music, comedy and spoken word. Tickets for this show are $25.
Click here for more details.
Winter Playground Thurs. – Sun.
Victoria School Grounds
From Crokicurl to sleigh rides and poetry readings, the grounds at Victoria School are where it's at for outdoor fun. There's facepainting, snacks and warm drinks, a fat bike demonstration and I know how many people want to try the outdoor highbred of crokinole and curling. These events are free. Make sure you bring the family.
Click here for details.
Returning Home Saturday
TCU Place
I couldn't let this column go by without talking about the Saskatoon Symphony Orchestra's show Homecoming. This is a show that features the return of two Saskatchewan artists. For the first time in more than a decade, Canada's first female music director and a University of Saskatchewan graduate, Tania Miller will take the helm as conductor of the SSO for this show. Also, master trumpeter Guy Few will be hitting the stage with the SSO to perform a new concerto by John Estacio. Tickets are $15 – $85.
Click here for all the details.


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On behalf of the Mothers, Fathers, Children and Teens of the Mighty Mid-Western Region, I welcome you to our website. The Mid-Western Region has a rich legacy of leadership, and we are committed to delivering innovative and creative programming for our children and all children.
We represent 38 chapters over eight states. Each of our chapters actively impacts its communities by delivering programs that equip children to be leaders today and in the future. Our focus remains leadership development and community service. Our Regional Executive Board is committed to implementing a vision that supports our regional theme- Living the Jack and Jill Experience: Mission-Minded, Dream Driven.
I am honored to serve as the Regional Director of this Mighty region. We look forward to contributing to our organization's 80 year history of excellence in children programming.
In Service,
Tanya Watson
Regional Director
Mid-Western Region


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Serviços Personalizados
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Links relacionados
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Salud mental
versão impressa ISSN 0185-3325
Salud Ment vol.34 no.4 México Jul./Ago. 2011
Artículo original
Rationale and state of the art in early detection and intervention in psychosis
Justificación y estado de la cuestión en la detección e intervención temprana en psicosis
Tecelli Domínguez Martínez,1,2 Joan Manel Blanqué,3 Jordi Codina,3 Mónica Montoro,3 Lluis Mauri,3 Neus BarrantesVidal1,3,4,5
1 Universitat Autònoma de Barcelona, Departament de Psicologia Clínica i de la Salut, Facultat de Psicologia, Barcelona.
2 Ministerio de Asuntos Exteriores y de Cooperación y la Agencia Española de Cooperación Internacional para el Desarrollo (MAECAECID).
3 Sant Pere Claver Fundació Sanitària, Departament de Salut Mental, Barcelona.
4 University of North Carolina at Greensboro, Department of Psychology.
5 Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain.
Neus BarrantesVidal.
Departament de Psicologia Clínica i de la Salut,
Factultat de Psicologia, Universitat Autònoma de Barcelona (UAB) 08193 Bellaterra (Barcelona), España.
Tel. +34 93 581 38 64.
Fax. +34 93 581 21 25.
E.mail: firstname.lastname@example.com
Recibido: 22 de diciembre de 2010.
Aceptado: 22 de marzo de 2011.
Schizophreniaspectrum disorders have a chronic and episodic course that results in impairment of all life domains. Pharmacological and psychosocial treatments provide symptom relief, but there is not a cure for schizophrenia and many patients suffer chronic impairment. In addition, it is expensive both in economical terms and also in terms of personal costs for both patients and their families.
International interest has grown over the past 15 years in the prognostic potential of early identification and intervention in the prodromal and firstepisode phases of psychotic illness. This focus is associated with increasing optimism about the benefits of implementing treatment as early as possible in the course of psychosis at least to help improve the course of illness, reducing its longterm impact.
The most recent epidemiological studies have shown that patients with longer duration of untreated psychosis (DUP) have worse shortterm outcomes in terms of treatment response, positive symptoms, negative symptoms, and global functioning. Neuroimaging studies have also indicated that prolonged untreated illness is associated with more pronounced structural brain abnormalities, while this is less prominent earlier in the course of the disorder. Therefore, early detection aims to reduce treatment delay in the hope of improving prognosis and reducing illness severity. Early intervention in psychotic disorders has gained momentum in the last decades, and there is now an estimated 200 centers worldwide offering specialized services for young people experiencing their first episode of psychosis. Each of these programs has unique characteristics and distinctive features in terms of treatment modalities and assessment tools, but most have a number of common elements and goals: a) early detection of new cases, b) reducing DUP, and c) providing better and continued treatment during the «critical period» of the early years of the disease.
Moreover, the role of family work in early psychosis can be crucial given that relatives are the main informal caretakers of persons with mental health problems. Family interventions in early psychosis usually offer psychoeducation and/or individual and group family therapy, communication and problem solving training, which can help to develop coping strategies and reduce distress and burden.
Intervention programs in early psychosis are usually composed by interdisciplinary teams, providing a wide range of integrated services that typically include psychoeducation, clinical case management, and group interventions. Specific interventions generally include pharmacotherapy, stress management, relapse prevention, social and employment rehabilitation support, and cognitive and family therapy.
Given the complex etiology and clinical manifestation of psychosis, treatment packages for people experiencing early psychosis need to be individually tailored to specific needs rather than applied homogenously across early psychosis patients.
The current challenge in the implementation of psychological interventions in the early stages of psychosis are: 1. to adapt treatment modalities that have been proven effective in stable and residual stages of the disease to its early stages; 2. to develop new forms of therapy tailored to the specific characteristics of these early stages of psychosis (prodromal and ultra highrisk phase, onset and first episode psychosis, and «critical period» or postcrisis psychosis); and 3. treatment packages need to be individually tailored to their specific needs rather than applied homogenously across a group of patients.
The aims of this paper are: 1. to present the basic concepts, rationale and state of the art of the early detection and intervention paradigm; 2. to review and present the main detection and intervention programs in early psychosis and 3. to provide an overview of the current psychotherapeutic approaches in early psychosis.
Key words: Early detection and intervention, early psychosis, psychotherapeutic approach, needadapted treatment.
Los trastornos del espectro psicótico presentan un curso crónico y episódico que provoca alteraciones en todas las áreas de la vida, generando importantes grados de discapacidad, pérdida de funciones psicosociales, grandes costos económicos, una comorbilidad considerable y sufrimiento tanto para los pacientes como para sus familias. A pesar de que los tratamientos farmacológicos y psicosociales han ayudado a aliviar los síntomas y mejorar la calidad de vida, en muy pocas ocasiones se logra una recuperación satisfactoria a nivel psicológico y funcional.
Durante los últimos 15 años, el optimismo creciente sobre la posibilidad de mejorar el pronóstico de la psicosis y alterar con ello el tradicional curso negativo de la enfermedad ha producido una reforma sustancial en la práctica clínica y en el desarrollo de estrategias de intervención temprana en muchos países. De esta manera, el desplazamiento del foco de atención desde las fases estables o residuales de la psicosis hacia los inicios de la misma está suponiendo una serie de innovaciones y avances, tanto en la evaluación y diagnóstico como en las modalidades terapéuticas y en la consiguiente reordenación de los servicios asistenciales.
Los estudios epidemiológicos más recientes han mostrado que los pacientes con mayor duración de la psicosis no tratada tienen peor respuesta al tratamiento farmacológico, mayor gravedad de síntomas positivos, síntomas negativos y peor funcionamiento global. Por otra parte, los estudios de neuroimagen también indican que un periodo prolongado de enfermedad no tratada produce anormalidades estructurales cerebrales más pronunciadas. Es por esto que la detección temprana en psicosis tiene como objetivo reducir la demora del tratamiento para mejorar el pronóstico y reducir la gravedad del trastorno.
La detección temprana y la aplicación del tratamiento específico más eficaz para cada fase inicial del trastorno son dos elementos que diferencian la intervención temprana de las formas habituales de asistencia actuales.
Cada vez existen más grupos en todo el mundo dedicados a establecer programas clínicos e iniciativas de investigación centradas en la psicosis temprana. Cada uno de estos programas tiene características particulares y rasgos propios en cuanto a las modalidades de tratamiento o los instrumentos de evaluación, pero la mayoría tiene una serie de elementos y objetivos en común: a) detectar de forma precoz nuevos casos; b) reducir el periodo de tiempo desde que el paciente presenta una sintomatología claramente psicótica hasta que recibe un tratamiento adecuado y c) proporcionar un mejor y continuo tratamiento en el «periodo crítico» de los primeros años de la enfermedad.
En el contexto de la prevención e intervención temprana, el trabajo con la familia puede ser crucial, ya que los familiares son los principales cuidadores informales y son una parte fundamental para la recuperación del paciente. La mayoría de las intervenciones familiares ofrecen psicoeducación y/o terapia familiar que ayudan a desarrollar estrategias de adaptación y afrontamiento, disminuir el estrés y la carga a largo plazo, así como mejorar la comunicación y la resolución de problemas.
Los programas de intervención en la psicosis temprana están habitualmente formados por equipos interdisciplinarios que proporcionan una amplia serie de servicios integrados que suelen incluir psicoeducación, manejo clínico de casos e intervenciones grupales. Las intervenciones específicas incluyen generalmente farmacoterapia, manejo de estrés, prevención de recaídas, apoyo y rehabilitación social y laboral, así como terapia cognitiva y familiar.
Dada la compleja etiología y manifestación clínica de la psicosis, los tratamientos para personas con psicosis incipiente deben ser adaptados individualmente a las necesidades específicas en lugar de aplicarlos homogéneamente a todos los pacientes por igual.
El desafío actual en la aplicación de intervenciones en la psicosis temprana consiste en: 1. conseguir adaptar aquellas modalidades de tratamiento que ya han demostrado su eficacia en las fases estables y residuales de la enfermedad a los inicios de la misma; 2. integrar y desarrollar nuevas formas de terapia que se adapten a las características específicas de cada una de las fases iniciales de la psicosis (fase prodrómica o de alto riesgo, inicio de la psicosis o primer episodio de psicosis y «fase crítica» o poscrisis) y 3. adecuar los tratamientos de manera individual en vez de aplicarlos de forma homogénea.
Los objetivos del presente artículo son: 1. presentar los conceptos básicos, la justificación y el estado de la cuestión del paradigma de detección e intervención temprana en psicosis; 2. hacer una revisión y presentar los principales programas de detección e intervención temprana en psicosis y 3. proporcionar una visión general de los enfoques psicoterapéuticos actuales en psicosis incipiente.
Palabras clave: Detección e intervención temprana, psicosis incipiente, tratamiento integrado y adaptado a las necesidades.
A conceptual change: From chronic schizophrenia to early psychosis
Schizophreniaspectrum disorders usually have a chronic and episodic course that results in impairment of all life domains. Patients frequently require hospitalization and many are unable to return to independent functioning in residual periods. Disorders typically start in late adolescence, disrupting patients' transition into adulthood.1,2
Pharmacological and psychosocial treatments provide symptom relief, but there is not a cure for schizophrenia and many patients suffer chronic impairment, which has huge social and economic costs.
In recent years there has been increasing confidence that preventive intervention in psychotic disorders might be a realistic proposition in clinical settings.3,4 International interest has grown over the past 15 years in the prognostic potential of early identification and intervention in the prodromal and firstepisode phases of psychosis, assuming that it could at least help to improve the course of illness, reducing its longterm impact.5 This is consistent with a recently adopted staging model in psychiatry, which emphasizes that less differentiated early phases of mental illnesses may benefit from a broader spectrum and simpler treatments, allowing young people to receive the help they need in a timely manner, with the potential for improved outcomes across several fronts.6 Thus, early intervention programs have been initiated worldwide, beginning with Yung, McGorry and colleagues7 in Australia and then moving to the United States and Europe shortly thereafter.
The early psychosis movement focused at first on the timely recognition and phasespecific treatment of firstepisode psychosis (FEP). However, it was also recognized that for most patients a prolonged period of attenuated symptoms and impaired functioning precedes FEP.1 Much of the disability associated with the psychotic disorders, particularly schizophrenia, develops long before the onset of frank psychosis and is difficult to reverse even if FEP is successfully treated.8 This preonset period of illness has been termed the «prodromal phase», characterized by various mental state features, including nonspecific symptoms such as depressed mood and anxiety, negative signs and symptoms as well as subthreshold or attenuated psychotic symptoms. Accordingly, the putative prodromal symptoms and signs can be divided into those that are more distal to the onset of psychosis (early prodrome) and those more proximal to the onset of psychosis (late prodrome).9 Nevertheless, the prodrome is a retrospective concept which cannot be deemed to have occurred until the onset of fullblown psychotic symptoms indicative of definitive psychotic disorder, when the opportunity for preventing onset has passed.1,10
The possibility to monitor prospectively those people at heightened risk for developing FEP lies in the new identification and followup of such population who demonstrate clinical high risk factors for subsequent psychosis, established as «atrisk mental state» (ARMS) and «ultrahigh risk» (UHR).11
The first study using UHR criteria found a transition rate of 40% to fullthreshold psychotic disorder within one year, despite the provision of needsbased psychosocial intervention and antidepressant treatment where indicated.12 This finding has subsequently been replicated by several groups internationally,13,14 including the recent multicentre North American Prodromal Longitudinal Study (NALPS),15 which reported an average 1year transition rate of 36.7% in UHR subjects who did not receive antipsychotic treatment. These results indicated that the UHR criteria are valid and reliable for predicting psychosis onset in this population.6
Unlike the predominant UHR approach, which only takes into account the severity of positive symptoms for meeting UHR criteria, the Hillside Recognition and Prevention Program (HRAP) in New York16 takes into account specific combinations of cognitive, academic and social impairments and disorganization/odd behavior.
Yung and McGorry17 were the first to develop operational criteria to detect UHR patients, resulting in the Comprehensive Assessment of at Risk Mental State (CAARMS). They distinguished three distinct highrisk groups to identify and follow prospectively the rate of conversion to psychosis: 1. attenuated positive symptoms (APS); 2. frankly psychotic positive symptoms that appear too brief and too intermittently to constitute a fully psychotic syndrome (brief limited intermittent psychotic symptoms, BLIPS) and 3. vulnerability group, characterized by functional decline in persons at risk for psychosis (because of meeting criteria for schizotypal personality disorder or having a firstdegree relative with a psychotic disorder). Moreover, Miller, McGlashan and colleagues developed the Structured Interview for Prodromal Syndromes (SIPS) and the companion Scale of Prodromal Symptoms (SOPS),18 which have become the prevailing prodromal instrument in North American studies, while the CAARMS has a predominating influence in Australia and many studies in Europe.
A different approach to early recognition was taken by German research groups, resulting in a set of criteria that are known as selfperceived cognitive and perceptual deficits, or «basic symptoms», characterized by subjective disturbances of selfperception, stress tolerance, thought organization, and social and nonverbal interactions that are generally not observed by others.19 The German concept of basic symptoms has been operationalized in the Schizophrenia Proneness Instrument Adult Version (SPIA)20 and recently adapted for child and adolescent population (the Schizophrenia Proneness Instrument, Child and Youth version SPICY).21
Rationale of early psychosis intervention
A key rationale for the early intervention paradigm has been the association between prolonged illness duration and poor outcome in the psychotic disorders. On the one hand, the duration of untreated psychosis (DUP) is negatively associated with the longterm symptomatic and functional outcomes in schizophrenia.22 Neuroimaging studies have also indicated that prolonged untreated illness is associated with more pronounced structural brain abnormalities, while this is less prominent earlier in the course of the disorder.23 On the other hand, research indicates that cognitive functioning deteriorates steeply before psychotic symptoms fully manifest.24 Thus, interventions delivered during the early phases of illness manifestation are believed to help preserve the individual's overall functional ability by reducing DUP and/or addressing the deterioration of functioning before FEP.25
Naturally, early detection raises important ethical issues26 as 60% or more ARMS will not, even without treatment, develop psychosis.27 However, it must be reminded that psychotherapy has been suggested as one approach for mitigating this problem by offering safe treatments,28 allowing delaying the onset of psychosis or ameliorating its severity once it begins, and thus it could also be unethical not to provide treatment to helpseeking or already disturbed individuals.
Moreover, the role of family work in early psychosis can be crucial given that relatives are the main informal caretakers of persons with mental health problems. In particular, relatives of schizophrenia patients report burden and distress, anxiety, depression and economic strain.29 High Expressed emotion (EE),30 which comprises overinvolvement, criticism and hostility, has been shown to be a robust predictor of relapse in both chronic and FEP patients.31,32 Even though it has been less studied in the early phase of psychosis, some studies have shown that high EE is already present in early psychosis.33,34 Given that the majority of ARMS and FEP individuals are adolescents or youngsters, investigation of family risk and protective factors would be essential for the design of developmentally appropriate early interventions.34
Main early detection and intervention programs
A clearer framework for guiding, designing, and evaluating preventive interventions in mental disorders has been developed. As a consequence, a series of research projects and realworld services systems are being created. Additionally, several influential international figures and research groups have developed and cooperated in disseminating a more optimistic set of ideas concerning early intervention in psychosis.3537
The focus on specific treatments aimed at preventing progression to psychosis or promoting recovery in those who have experienced a psychotic episode has tended to be classified into three main categories: 1. prodromal or «highrisk» phase; 2. onset or FEP; 3. postpsychosis phase, also known as «critical period», covering the period following recovery from FEP up to five years subsequently.38
Most groups working with the UHR population have attempted to engage patients in various psychological interventions using a recovery model of treatment. These interventions include case management, individual therapy, psychoeducation and CognitiveBehavioral Therapy (CBT), multifamily support groups and supported education and employment.39 However, specific family interventions, such as problem solving and communication skills training, have also been suggested as possible interventions that may improve the functional prognosis of young people at UHR for psychosis.40
The main early detection and intervention services and research programs are presented in table 1. Given that each program has numerous publications, table 1 shows only the references of those articles that describe the programs and those with the most recent findings. For more information, we also include some of the available websites of the programs.
Psychotherapy takes place in diverse settings, with diverse groups, utilizing a bewildering array of techniques and styles informed by a vast array of theories and ideologies.
Usually, the most widely used interventions in psychosis are psychoeducation and CBT. A multitude of studies have demonstrated a clear superiority of psychoeducational family interventions as compared with standard treatments,64 and may be considered both clinically beneficial and costeffective.65 However, it is well known that psychoeducation by itself may not be sufficient to reduce the consequences of the experience of caregiving for a family member of a psychotic patient and, therefore, it has to be seen as a precursor and catalyst for subsequent complementary psychotherapeutic and psychosocial treatment strategies.64
Moreover, in regard to CBT, there are controversial results and its effectiveness is still not entirely clear for the early phases of psychosis,66 because only a small number of controlled trials of CBT in early stages of psychosis have been published.67 In contrast to the substantial body of positive findings for individual CBT treatment of chronic psychosis, the majority of data on individual CBT for early psychosis is not favorable.68
On the other hand, the relative shortage of systematic research in modern dynamic models can give the impression of a lack of positive results, unlike CBT techniques.69 In fact, therapies based on psychodynamic traditions do not feature greatly in recent discussions, and more research is needed to provide relevant answers to the unsolved questions regarding their usefulness and efficacy in early psychosis intervention.70 However, this tradition probably has most extensive experience and elaborates conceptions for dealing therapeutically with cases in the borderline area of normality and psychosis.26
No single type of therapeutic activity is ideal for all patients. Different subgroups of patients require different approaches within a broad spectrum of psychotherapeutic models. There is a clear need for a broader theoretical foundation of a set of therapeutic techniques, and also for the ability of greater depth and duration of therapy.71 The stressvulnerability model, along with advances in research of CBT, has been an opportunity for the fusion of dynamic and cognitive approaches, such as in the cognitive analytic therapy72 or the psychodynamicinterpersonal psychotherapy73,74 which rely less on direct interpretations than in conventional psychodynamic therapy and make more emphasis upon the patienttherapist relationship than in interpersonal therapy or CBT. Although the experience of these integrative models is still limited and requires more extensive and systematic formalization and evaluation, it seems that their recent development could play a useful role in the expansion of psychotherapeutic theory and practice.72
The current challenges for psychological interventions in early psychosis are: 1. to adapt treatment modalities that have been proven effective in stable and residual stages of the disease to early psychosis and 2. to develop new forms of therapy tailored to the very specific characteristics of the early stages of psychosis.75
Given the complex etiology and clinical manifestation of psychosis, treatment packages for people experiencing early psychosis need to be individually tailored to specific needs rather than applied homogenously across early psychosis patients.76 One example is the work of the group leaded by Alanen et al.77 in Finland, which has created a needadapted treatment approach, considering in each case both individual and interactional factors. They combine different forms of treatment in a flexible, individually designed intervention in order to take into account the needs of both patients and families, using psychoeducational principles in combination with medication, family intervention techniques, and individual psychotherapy.
Following this example, the Sant Pere ClaverEarly Psychosis Program (SPCEPP), currently being developed in Barcelona, is an integrative model and needadapted treatment always planned individually and taking into account the therapeutic needs of both patients and the people closest to them, based directly on the work of Alanen et al.77 This clinical program is attached to an early psychosis research project conducted by the Universitat Autònoma de Barcelona (UAB), which is presented in Domínguez et al.
The shift in focus from the stable or residual phase of the illness towards its initial stages has led to a series of innovations and advances not only in assessment and diagnosis, but also in therapeutic approaches, with the consequent reorganization of care services and health policies.75
Increasing evidence suggests that it is possible both to identify individuals who may be at risk of developing psychosis, and subsequently reduce or delay the transition to psychosis, as well as to ameliorate the severity of nonpsychotic symptoms and distress. Nevertheless, and despite this encouraging work and findings, more research is needed to provide relevant answers to the unsolved questions regarding the usefulness and efficacy of early intervention in psychosis.70
Although recently published reviews on interventions in ARMS concluded that the effects of interventions are currently indecisive,71 and even though the costeffectiveness of early intervention is still scarce, recent evidence suggests that early intervention in psychosis may not only improve the clinical course of psychotic disorders, but also make such disorders less costly to treat compared with more traditional forms of care.78 However, more research on the efficacy of early intervention is needed to demonstrate the extent to which the benefits persist in the longer term.79
Bringing treatment more rapidly to a person who has become psychotic is in itself enough to justify early detection efforts.80 However, the highlighted ethical issues need to be considered seriously when working with young people thought to be at risk of developing psychosis, and further work is therefore needed to investigate and improve intervention options. Finally, despite the emphasis on prevention, it is also important not to forget those patients with a poorer prognosis in need of a long and continuous attention.
This work has been possible thanks to the support by the Fundació La Marató TV3 (091110). Neus BarrantesVidal is funded by the Spanish Ministry of Science and Innovation (Plan Nacional I+D+I PSI200804178), and the Generalitat de Catalunya, Suport als Grups de Recerca (SGR2009672). Tecelli Domínguez Martínez thanks the Spanish Foreing Ministry (MAECAECID) for PhD grant. We want to specially thank Elías Vainer, Mercè Jané, Iván Torices, Ma. Antonia Massanet, Ramón Berni, Cristina González and David Clusa for their comments and collaboration in the preparation of this manuscript. Finally we thank the support offered by Fundació Sanitària Sant Pere Claver.
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text:
Johannesburg is a city people either love or try to avoid. Its history is fascinating and tells the tale of a city formed on the fringes of gold mines — earning it the nickname "The City of Gold." For this reason, I find the city to be one filled with stories of people that speak of formation, history, struggle, and the future. It's vibrant, fast-paced, and has some very trendy, very cool neighbourhoods. The inner city has undergone a transformation over recent years in an attempt to draw people back into the urban hub of Jo'burg and offers many things to do and places to explore.
If you're planning to be in Jo'burg on a Saturday, Neighbourgoods Market is a must-see. As part of a city rejuvenation project with the goal of drawing people back into the inner city, this market in the heart of Braamfontein offers a culinary delight for foodies. On the first floor a variety of food options await: delicious Mediterranean,spicy Indian with a typical South African flair offer Bunny Chows to oysters accompanied with wine, freshly steamed dim sum, flavoursome Thai curry, and gorgeous vegan African dishes. The options are limitless! Wine, craft beers, and a gin bar provide fantastic company for the local band that brings the entertainment. This part of Jo'burg is my favourite — it brings together a mix of cultures in a beautiful urban setting decorated with graffiti. While Braamfontein has much to offer, do not plan on spending a Sunday here as the city has spent itself on the Saturday and almost everything is closed on Sunday, save a coffee shop or restaurant or two.
On a Sunday, Market on Main in the Maboneng precinct, a short distance from Braamfontein, has a vibe similar to that of Neighbourgoods. Many of the same enticing food vendors sell their food goods, but Latin music and dance classes on a rooftop will have you sampling different drink options while dancing into the evening. Alternatively the surrounding district has many places to dine on offer.
If you're planning on spending time in the City of Gold during the week, you'll find Service Station just as you enter Melville. With a delightful breakfast menu sourced from seasonal ingredients and the best independent bookshop right next door, you can spend a lovely hour or two at this spot over a cup of coffee or two or three (as I would have it). Check out the store selling food products and unique kitchenware on your way out.
For lunch, I would recommend heading to Parkhurst. On Fourth Street, a variety of restaurants await to be sampled. My favourite is Wolfpack. Specialising in gourmet burgers and craft beers and sides such as sweet potato chips with hummus or polenta fries with strawberry preserve and crème fraiche you will find something for every palate from vegan to carnivore. Their special, the Big Bad Wolfe, stuffed with cheese and topped with wasabi onion rings and pineapple, can be ordered accompanied with a howl to add to the atmosphere. Small and intimate, you might consider booking ahead of time if you plan on taking a few friends with you.
Dinner options abound! In the Maboneng precinct, Pata Pata serves a variety of South African dishes, from traditional potjie kos (inspired by Afrikaans tradition and cooked in iron cast pots over an open fire) to Indian dishes and stews. By simply walking into the restaurant your senses tell your brain that you're in for an immense treat! If you have a few more Rands to spare, you cannot go wrong with a dinner at Moyo restaurant. You'll find one in the beautiful Melrose Arc or Zoo Lake. Offering a unique African dining experience accompanied with fun face paint suited to adults, their menu is inspired by the traditions and values of African ancestors. Delicious and enchanting, Moyo offers African elegance.
Monte Casino always has a selection of shows on offer in their two theatres, the bigger Teatro at Monte Casino which has produced shows such as Mama Mia, Dirty Dancing, and Phantom of the Opera, or the smaller Pieter Toerien theatre which is currently running a production of Joseph and the Technicolour Dreamcoat as well as local comedic productions that always guarantee a good laugh. If theatre is not your cup of tea, the complex also offers a gambling floor and numerous restaurants. Currently a Coffee & Chocolate show offers a visual and sensory experience. On a nice day, wonder into the park where you can watch a show or just marvel and get up close with beautiful, multicoloured feathered creatures.
Emmerentia Dam is a wonderful idea for a day out in the sun. A canoe ride on the dam and basking in the sun offer a breath of fresh air just outside of the main city centre. If you time your stay right, you might be able to catch an international music act in the park ranging on the dam.
Tour guides always come with an endless list of museums to visit but the Apartheid Museum is a one-of-a-kind museum that tells the story of the rise and fall of the apartheid regime and is a definite must-see for anyone interested in the history of South Africa or in generally expanding their understanding of the current state of the country. It will provide insights into the current state of South African society and help you understand why the country has such a huge socio-economic inequality ratio especially in terms of race. Unique interactive displays will capture your attention and manage to inform the visitor in a creative manner through the use of different kinds of media. You may find it a challenging experience but it certainly is an enriching, eye-opening journey of self-exploration that will take you on an emotional rollercoaster of heartbreak and inspiration.
Soweto, a township in the city of Johannesburg with a population of about a million people, is infused with South Africa's rich history and the struggle against apartheid. Its name is an acronym derived from South Western Townships and it is the most metropolitan and progressive township in South Africa. Soweto sets the trends in contemporary South African music, dance, fashion, and politics. You can easily spend an entire day in this township, so be sure to set aside enough time if this is a place you would like to see. Points of interest include the Orlando Towers where you can be daring and bungee jump as well as the Hector Pieterson Museum which speaks to the struggles of the youth during apartheid. Take a stroll down Vilakazi Street which is the only street in the world to have housed two Nobel Laureates, Nelson Mandela and Desmond Tutu. The Vilakazi street precinct is about a kilometre long has been transformed into a must-see street laced with art works. Nelson Mandela's house on 8115 Vilakazi Street where he lived prior to being imprisoned has been transformed into a museum. A place of contrasts between rich and poor, and a monument to the past and present, Soweto has an exuberant, vibrant, racy energy that one finds only in Johannesburg. For a good time, drop by one of the many shebeens, another name for an illegal tavern during apartheid, in Soweto. Wandie's Place is popular with both locals and tourists alike who are spoiled for choice from a buffet offering indigenous cuisine.
For a night out, The Orbit in Braamfontein is a live jazz venue and bistro. It offers a platform for jazz musicians to express their creativity and is one of the hot spots in the city with a constant line-up of fresh music. The Orbit is open from Tuesday to Sunday from 4 p.m. to 1:30 a.m., and performances usually start at 8 p.m. from Tuesdays to Saturdays and at 6 p.m. on Sundays. For those without an affinity for the soulful sounds of jazz, Great Dane also situated in Braamfontein brings back memories of old Johannesburg. The floor alone is a site to behold, crafted out of coins. Open until the early hours of the morning, it's one of the most popular venues in Johannesburg's nightlife scene.
Bassline, originally opened in Melville but now located in Newtown, is a live music venue with a great atmosphere that hosts a variety of gigs, events, and comedy. Considered by some as the best weekly party, Bassline has two levels with a bar on each level. It's hosted and launched a variety of big names in music. With a lineup throughout the week, surrounded by neighbourhoods inhabited by young souls, you're in for a good night out.
For some good old thrift shopping, Seventh Street in Melville has a few shops in which to browse for lost treasures from vinyl to clothes and bric-a-brac. Catch a cup of coffee at Bread and Roses on your way up the street and a refreshing beer at Hell's Kitchen upon your return down the street. Keep an eye out for local vendors selling beautiful African fabrics and wooden serving platters.
Sandton Mall, a more commercial mall located in Africa's richest square mile, hosts shops offering everything from clothing to souvenirs to homeware, and prides itself on African hospitality and international style. Be sure to snap a picture of the six metres tall Nelson Mandela statue in Nelson Mandela Square.
Rosebank Mall, also conveniently located on the Gautrain line along with Sandton, will provide for hours of shopping, from international brands to more local merchandise. For a more local market experience, wander onto the rooftop market where you can browse for African handicrafts.
For the businessperson or those in search of a splurge, the five star Michelangelo Hotel perches atop Nelson Mandela Square. Oozing luxury in every detail, the Renaissance-style architecture is the precipice of success and status. It offers 242 suites and rooms and world-class facilities and is conveniently located within close range of some of the best shops and restaurants in Sandton and its surrounds. Be warned, however, to come braced with a bank account to match the prestige and luxury.
The Bannister Hotel in Braamfontein offers a more affordable option. Located next to Great Dane, it's a luxury budget hotel. The Bannister is a hot spot providing locals with live bands and entertainment in the bar area. The rooms have a fresh, young vibe and apart from the great location close to main Johannesburg sights and sounds, provide a comfortable and convenient stay.
Airbnb has burst onto the scene in Johannesburg. With a website that provides pictures, descriptions, and reviews, you can find accommodation in the area of your choice—sometimes quite luxurious but at a very affordable price close to what you would like to experience in Egoli, the place of gold.
Have you been to Johannesburg (or do you live there)? What else would you add? Email firstname.lastname@example.com if you're interested in contributing to a "24 Hours" Guide!


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What is contact dermatitis?
Many substances at home or at work may produce skin irritation or even skin ulcers.
This is known as dermatitis by contact. You should know what product can be responsible, how to know if you are affected and what medical treatment you can follow.
Characteristics of contact dermatitis
Contact dermatitis is a type of non-infectious dermatitis produced by the reaction experienced by the skin to contact with an irritant substance.
This type of reaction can occur immediately or after some time after the contact.
It mainly affects adults and it usually does not extend beyond the irritated area unless it touches another part of the body.
It is produced mainly in the feet, hands or groins.
Types of contact dermatitis
There are two types of contact dermatitis:
- Irritant contact dermatitis: It is the most common and occurs when substances that come in contact with skin produce lesions in it, which can range from simple irritation or redness to the creation of festering sores. This type of dermatitis mainly affects workers who are often in contact with irritating acidic or alkaline substances.
It is an important reason of absenteeism at work since it concerns different professions who come into contact with products that, in continuous and prolonged exposure, affect the skin.
Some professionals are specially subjected to possible dermatitis by contact.
Among the most affected occupations we can include: hairdressing, animal husbandry, gardening, floristry, construction, carpentry, leather industry, heavy metals, industrial or domestic cleaning, army, health, education, etc.
Among the irritants that can cause this type of dermatitis we have, for example, hairdressing dyes, chalk, gypsum in construction, carpentry strippers, fungicides, gardening products, etc.
- Allergic contact dermatitis It is a type of manifestation at any one time produced when the skin produces immune reactions to any particular product. It does not produce a direct injury to the skin, which is affected by an irritant or corrosive substance. In this case, the immune system reacts disproportionately causing injury to its own tissues.
The trigger for this type of contact allergy can be varied as there are many substances that can induce it: perfumes, metals, cosmetics, pesticides, latex, medicines etc.
Although the causes that produce it are different from the ones that produce irritant contact dermatitis, in many cases result in similar consequences. Allergic dermatitis is not as common as the irritating type, as it only usually occurs about 20 to 30% of cases versus contact dermatitis.
Symptoms of contact dermatitis
Itching, redness, swelling in the most benign or, what is worse, the appearance of blisters with oozing pustules that produce dry scabs or raw sores.
At other times, they form thickened areas or dry skin.
Many irritant contact dermatitis are very similar to those given by allergic contact dermatitis. Sometimes the former are more easily distinguished because they show symptoms similar to burns.
Causes of contact dermatitis
The causes of contact dermatitis are irritants or allergens. Among the main ones, we can point out the following:
The simple contact with ivy can produce bad skin reactions in many people.
- Allergen or irritant plants: Many plants are known to cause contact dermatitis. Some contain ingredients such as oxalic acid, as the case of wild arum. Others, like rue, have furocoumarins with phototoxic properties, and can cause dermatitis when the skin is exposed to contact with the sun.
Other very irritating plants are rosebay, spurge, ivy, elder, sumac, Morning-glory at night, dumb cane, clematis, the sea poppy, pothos gold, spurge flax daphne, honeysuckle, ginkgo, (See more toxic plants)
Essential oils of some medicinal plants, placed in contact with skin, if not diluted properly or in very sensitive skins, are also responsible for cases of dermatitis. Between these we have, for example: anise, eucalyptus, grapefruit, lavender, etc.
Some spices used to flavor foods, when they reach the skin directly, can also produce similar effects. Among them we have, for example, cinnamon.
Some very used home chemicals, such as mail polishes, can be the reason of skin inflammations
- Chemical agents: Other times, contact with chemicals at home or at work is responsible for these reactions on the skin. Among the many household products that can cause contact dermatitis we can include: detergents, solvents, nail polish, adhesives, cleaning products, perfume, chlorinated water, soaps, shampoos, shaving lotions, sunscreens, and even drugs, especially those applied to the skin. In the chemical industry, adhesives, solvents, paint strippers, pesticides, etc. are the cause of countless cases of contact dermatitis.
- Metals and alloys: Sometimes contact dermatitis is caused because of allergy to metals, including those used in jewelry such as gold or alloys such as nickel, used in bracelets, rings, wrist watches, etc.
Some clothes made of wool can be responsible for contact dermatitis in some people
- Textile fibers: Allergy to certain textile fibers such as wool, can also trigger it. Latex is responsible for many cases of contact allergy. It is quite common to suffer this type of allergy from products made from this material as condoms, bathing caps, gloves or shoes.
- Insect bites: Within these adverse reactions we could also indicate those that take place by insect bites, like lice, fleas, bees, ticks, etc.
Diagnosis of contact dermatitis
The diagnosis of contact dermatitis is conducted through a medical review by the physician of the affected areas of skin.
To find the substance that causes adverse reactions, your physician, in addition to a physical exploration, usually will performed a questionnaire on your professional activity, useful to determine in many cases the specific cause of the dermatitis.
Other times, when the exploration and the interview fails to elucidate the exact cause, a series of tests can be carried out by the skin specialist:
- Skin allergy testing: The skin is put in contact with certain substances to see what kind of reactions occur, which will allow the determination of the exact cause of these processes. (Finn chamber test).
- Skin microscopic analysis: It may even be necessary a microscopic analysis of tissue samples.
Ordinary treatment of contact dermatitis
The ordinary treatment of contact dermatitis requires the participation of the doctor or dermatologist because there are many types and each one may require a different treatment.
In general, the first treatment is to avoid contact with the product that caused the dermatitis and implement a range of creams, many with corticosteroids, and skin softeners.
It is also recommended:
- Not to use chemicals to wash the skin
- Wet the skin as less as possible
- Avoid sudden temperature changes.
In some cases it may be necessary to change jobs in order to avoid contact with substances that cause contact dermatitis.
Natural treatment of contact dermatitis
Natural treatment of contact dermatitis supposes the use of a series of natural resources that can help to prevent or to improve the symptoms of this anomaly.
More information on the natural treatment of contact dermatitis and other types of dermatitis.
6 April, 2020


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Intermountain Healthcare has embarked on a remarkable journey of extending its telemedicine consultation program to infectious disease (ID) conditions, helping sixteen hospitals in its system and beyond.
1. Give us an overview of this program and its structure.
When I joined Intermountain Healthcare a year ago, the telehealth and telemedicine program was well-established, especially for critical care. The purpose of the new Infectious Diseases Telehealth program is not only to provide consultative advice for individual patients, but also to provide population-level input on antibiotic usage and disease condition monitoring, to all providers within the Intermountain system. These services are of great value for small community hospitals in Utah and Idaho that might not have access to resources like sub-specialist physicians, ICUs, and databases. In 2015, one of our providers fielded approximately 1000 phone calls from small community hospitals over approximately 15 months, addressing and answering their infectious diseases needs. The demand was evident, and consequently, we implemented a formal program to support all sixteen community hospitals. Any physician, mid-level provider, nursing staff, pharmacist, or administrator concerned about an individual case or a rising trend in infectious diseases can request our expertise.
The ID telehealth consultation service is provided at three levels. The first one is in the form of telephone advice, which we provide 24/7 for the entire year and is usually requested by clinicians who require prompt infectious disease expertise for managing their patients' needs. Secondly, since we have access to system-wide EHR and EMR data, we can review a chart and give more comprehensive consultative recommendations to individual clinicians that request it, in a more formal manner, which is called an e-Consult. The third and most comprehensive input is in the form of a full-fledged telemedicine visit to the patient using two-way audiovisual (AV) technology, where we go into the room electronically and talk to the patient. This is essentially a full consultation to provide expertise for a very specific condition and help guide the small community hospital provider in the management of their patient.
"The whole concept of the ID telehealth program is to provide centralized expertise to empower small community hospital staff"
At a population level, we use a proprietary software known as Vigilanz, which is tied to our EHR, monitoring all antibiotic use and specific disease conditions (e.g. blood stream infections) as part of a system-wide antimicrobial stewardship (AMS) program. In the first ten months of this program, we monitored system-wide infectious diseases and found that bloodstream infections accounted for approximately 45 percent of all ID cases.
2. With this program, what is Intermountain's role in the larger scheme of AMS?
There was a nation-wide push to combat the overuse of antibiotics and antimicrobial agents after the White House announced the National Action Plan in 2014. The Centers for Disease Control (CDC) subsequently created guidelines and recommendations on antimicrobial stewardship programs for all hospitals. Thereafter, the Joint Commission for the accreditation of hospitals, and the Centers for Medicare and Medicaid Services (CMS) chimed provided additional requirements and conditions of participation. Each facility in the Intermountain Healthcare system has a team comprised of a physician champion, a pharmacist champion, a patient safety or quality management representative and, depending on the size of the hospital, nursing staff and administrative leadership. These teams implement their antimicrobial stewardship program, with the guidance and direct involvement of an ID physician and an ID pharmacist centrally.
An ID pharmacist and physician connect with all sixteen AS teams electronically in each of their quarterly meetings, and meet in-person with each of the small community hospital stewardship teams annually. With our access to population-level data fromthe CDC's National Healthcare Safety Network, Vigilanz surveillance, and our integrated system-wide EHR, we provide the AS teams centralized data that they can directly act upon to help reduce the inappropriate use of antibiotics, decreasing antibiotic resistance, and improve individual patient care.
We recently added a system-wide monthly education program, known as the Education in Antimicrobial Stewardship and Idea Exchange (EASIE). All the individuals and teams collaborate on a WebEx platform, and we provide education on common antibiotic use issues and specific disease topics, followed by an idea-sharing segment where the AS teams can discuss recent challenges and solutions in their respective hospitals. The whole concept of the AS program is to use centralized resources (ID subject matter expertise and central data monitoring) to then empower local AS teams to make decisions on what projects they want to work on based on their own unique issues and population-level data.
To that end, these initiatives have been very rewarding, giving us an opportunity to provide far-reaching education using technology, in addition to facilitating interactions between these AS teams. The ID physician and ID pharmacist are integrated as part of each small community hospital's AS team.
3. How has this program been received by physicians and patients, and where do you intend to proceed with it?
After the first 6 months of the ID telehealth program, we conducted surveys of patients, physicians, nurses, pharmacists, and administrators. The mean age of patients surveyed was 63 years, and to our delight, we scored between 97-100 percent on our program assessments for patients and providers. We have had many teary-eyed elderly patients, who have never used a smartphone or computer, state that they wish this technology and service could be available to everyone, everywhere. Our program helps patients like these stay close totheir families and communities, avoiding transfer to a distant large hospital due to a lack of subspecialty resources. It is also amazing how small community hospital providers have used the telemedicine-based expertise to create better patient experiences and clinical outcomes. Despite initial concerns by some of our telemedicine providers that they might lose some of the personal connection with their patients, they have been pleasantly surprised to find the same level of patient-physician connection and impact using a telemedicine platform.
There have been three new developments that impact our telehealth program greatly:
a. We switched to a new EHR that allows us to extract data more effectively, making us more efficient in delivering care to a broader number of providers and patients.
b. The EHR is also well integrated with Vigilanz and other antibiotic use-monitoring systems, making the data instantly available on those platforms. This is a part of the macro-trend of system interconnectivity we see in the healthcare sector.
c. Last year, Intermountain also expanded the telemedicine capabilities of other specialties such as wound care and oncology. We have also grown geographically, reaching small community hospitals outside of the Intermountain Healthcare system, as part of our Telehealth Outreach program.


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Serving Overland Park, Lenexa, Prairie Village, Shawnee, & the Greater Kansas City Area.
Local Business - Global Network®
BNI® is the World's Largest Business Networking, Referrals, and Word of Mouth Marketing Organization.
About Us
Contact Us
Due to COVID19, we have moved our meetings online via Zoom.
We still meet every Thursday at 7:30am.
and join us (we'll send you the link).
We'll get through this by supporting and helping one another!
About Us
Our Philosophy
The philosophy of this organization is built upon the idea of "Givers Gain®": By giving business to others, you will get business in return. This is predicated on the age-old idea of "What goes around, comes around."
Our Mission
The mission of BNI is to help members increase their business through a structured, positive, and professional "word-of-mouth" program that enables them to develop long-term, meaningful relationships with quality business professionals.
Belonging to BNI is like having dozens of sales person working for you...
...because all of them carry several copies of your business cards around with them. When they meet someone who could use your products or services, they takeout your card and recommend you.* It's as simple as that! It's simple because it's based on a proven concept by BNI Founder, Dr. Ivan Misner, called "Givers Gain®." If I give you business you'll give me business and we'll both benefit as a result.
Last year alone, members of BNI passed 6.5 million referrals...
...which generated over $2.8 billion dollars (U.S.) worth of business for its members! BNI is a business and professional networking organization that allows only one person per professional classification or specialty to join a chapter.
Would you like to increase your business by 20%, 30%, 50% or as much as 100%?
You can see results like this! Many have. Some participants have added as many as 50 new clients in the first 2 years!!! Successful businesses depend on word-of-mouth. Word-of-mouth advertising is the best advertising there is.
BNI provides a structured and supportive system of giving and receiving business.
It does so by providing an environment in which you develop personal relationships with dozens of other qualified business professionals. By establishing this "formal" relationship with the other person, you will have the opportunity to substantially increase your business.
(*) Note, some professions, specifically attorneys and certain health care professionals, may not be permitted to seek direct referrals through in-person solicitation through the use of business cards pursuant to their ethical code. Members of BNI that belong to these professions are directed to follow their profession's own ethical guidelines.
BNI Overland Park 10
Created by Agility


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Google ranking is the most significant contributor to effective SEO. Our London SEO experts follow and keep up to date with the latest Google ranking factors
The first step in improving your London search engine rankings is to optimize your site's content
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With your London SEO strategy in place, it is time to build quality links and profiles in line with Google Ranking Factors


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FARMINGTON — While some residents expressed concerns about the town's proposed $57.24 million sewer plant improvement project Tuesday, officials said the town could stand to lose up to $12.3 million in state grants if the project isn't approved by voters.
Town Manager Kathy Eagen said that the town is working toward presenting the project at a November referendum.
"If it doesn't pass, the state will mandate the town to take action on upgrading the facility," Eagen said at the council meeting Tuesday. "The town might lose the grant funding opportunity."
Michael McLaughlin of Worthington Drive asked the council how much of the cost of the project will be borne by Avon, Burlington and Canton, who use the Farmington facility.
Eagen said each of the towns and the UConn Health Campus file permits with the state that shows how much they use the treatment plant. She said those towns and the health center are projected to contribute about $9.26 million toward the project.
"If they go past what their permit requires, we do have the option to go back and charge them more for the use," Eagen said.
Eagen told residents that the first year, the upgrade will increase taxes by $133, but that amount will decrease by about $6 each year over 20 years.
Eagen said because the water treated at the Farmington facility is used by the schools, municipal buildings, other towns and the UConn Health Campus, the project comes down to a public safety issue because the current facility doesn't meet state Department of Energy and Environmental Protection requirements.
Residents who spoke at the meeting raised concerns about noise and construction, but Eagen said most of the construction will be inside and residents are likely to hear trucks backing up and some truck horns.
If the project is approved at referendum, construction is scheduled to start in 2015 and continue for three years.
"This project has been thoughtfully planned with a tremendous amount of due diligence for years," council member Meredith Trimble said.