Literature Collection

OBJECTIVE: To examine the associations between unhealthy alcohol use and risk of coronary heart disease (CHD) among women and men aged 18-65 years. METHODS: An observational study in an integrated healthcare system with systematic alcohol screening. We identified 432,265 primary care patients aged 18-65 years who, in 2014-2015, reported weekly alcohol intake levels. Weekly alcohol intake, categorized into below (≤14/week men; ≤7/week women) and above limits (≥15/week men; ≥ 8/week women) per U.S. guidelines, and heavy episodic drinking (HED, ≥5/≥4 drinks any day in past 3 months for men/women, respectively). Main outcome was CHD during 4-year follow-up, based on inpatient ICD diagnoses of myocardial infarction and CHD. Cox proportional hazards models adjusted for age, sex, race/ethnicity, body mass index, physical activity, smoking, hypertension, diabetes, and hyperlipidemia. RESULTS: The cohort comprised 44 % women, mean age (standard deviation) of 43.5 years (±13.1). Weekly alcohol intake above limits was associated with higher prevalence of cardiovascular risk factors, and a 26 %, 19 % and 43 % higher risk on the overall, men- and women-specific risk of CHD after adjusting for these risk factors (hazard ratio [95 % confidence interval] = 1.26[1.13 -1.40], 1.19[1.04-1.35] and 1.43[1.20-1.71], respectively). CONCLUSIONS: In a large, real-world, diverse population with a systematic alcohol screening program, having weekly alcohol intake above limits was associated with increased risk of CHD among young and middle-aged men and women. Increased CHD risk due to alcohol intake above limits warrants particular awareness and interventions.

BACKGROUND AND AIMS: Australia recently down-scheduled and authorised psychedelic-assisted therapies, including psilocybin, for certain mental health conditions. Evidence is emerging for potential application in substance use disorder treatment. However, regulatory developments have outpaced implementation readiness. While service leaders and clinicians are crucial to implementation, little research examines their perspectives on what psilocybin-assisted therapy is, how it works, and for whom. This study explored how these stakeholders conceptualise psychedelic-assisted therapy within their own professional setting, in the context of a broader implementation trial of psilocybin-assisted therapy for co-occurring depression and alcohol use disorder (AUD) in a routine alcohol and other drug (AOD) clinic. DESIGN: A qualitative approach informed by the evidence-making intervention approach. SETTING: Victoria, Australia, prior to the implementation of psilocybin-assisted therapy in routine clinical services. PARTICIPANTS: Two focus groups were conducted: one with clinicians (n = 9; nursing, psychology, psychiatry, pharmacy, and peer support professionals) and one with health service leaders (n = 9). MEASUREMENTS: Focus groups used a semi-structured guide, consisting of open-ended questions about understandings and perspectives on psilocybin-assisted therapy for co-occurring substance use and mental health problems. Verbatim transcripts underwent inductive thematic analysis, informed by the evidence-making intervention approach. FINDINGS: Three enactments of psilocybin-assisted therapy emerged: (1) treatment of last resort for treatment-resistant conditions, which was emphasised by service leaders and aligned with regulatory frameworks; (2) tool to "unlock stuckness" in ongoing relational care when conventional therapies plateau, which was prominent among clinicians; and (3) catalyst for rapid progress applicable at any treatment stage. Clinicians emphasised the need for careful integration, robust support, and aftercare, alongside concerns about access and eligibility. Service leaders highlighted operational and ethical tensions within regulatory requirements. Both groups understood psilocybin-assisted therapy as a complex intervention dependent on interplay between medication, therapist skill, client readiness, and care context. CONCLUSIONS: Psilocybin-assisted therapy in Victoria, Australia is constituted through local implementation rather than existing as a singular intervention. Implementation approaches must be reflexive and adaptive, with attention to clinical and managerial dialogue, equity considerations, and contextual practice factors.

BACKGROUND: Early onset of mental health disorders is common, but many cases remain undetected and untreated, highlighting the need for early intervention. In Canada, youth mental health services face challenges, including fragmentation and resource limitations. Integrated youth services (IYS) aim to address these gaps for individuals aged 12-24 years. Mobile health (mHealth) programs, like Foundry Virtual BC, offer potential solutions, yet their integration and sustainability within IYS require further exploration. OBJECTIVE: This study examined interest-holder perspectives on creating a sustainable, youth-centred mHealth system to improve mental health outcomes. The research focused on three questions: (a) How do users, service providers, and nonclinical staff perceive mHealth's effectiveness and impact? (b) What are the barriers and facilitators to mHealth integration within the Foundry IYS network? and (c) What strategies support the sustainability of mHealth services? METHODS: A qualitative study using semi-structured interviews was conducted with 23 interest-holders, including youth users, service providers, and nonclinical staff from the Foundry network. Participants were recruited via social media and snowball sampling. Thematic analysis identified key themes and subthemes. RESULTS: Three themes emerged regarding mHealth perceptions: (a) its own value, (b) its potential to address barriers to in-person care, and (c) its inherent limitations. Barriers and facilitators of mHealth integration were categorized into three domains: (a) design characteristics (e.g., app usability and content quality), (b) individual youth factors (e.g., privacy concern and inner struggle), and (c) external factors (e.g., safe space and support from peers). Sustainability was linked to service quality and external support. CONCLUSION: This study highlights the complexity of mHealth integration within an IYS network. Interest-holders emphasized addressing user motivations, privacy, and accessibility while advocating for co-design approaches to ensure mHealth meets diverse youth needs. Future research should focus on underrepresented groups to promote equity and improve mental health outcomes through sustainable mHealth solutions.