***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Some studies in first-episode schizophrenia correlate shorter duration of untreated psychosis ( DUP )  with better prognosis , suggesting that timing of treatment may be important . A three-site prospect i ve clinical trial in Norway and Denmark is underway to investigate the effect of the timing of treatment in first-episode psychosis . One health care sector ( Rogal and , Norway ) is experimental and has developed an early detection ( ED ) system to reduce DUP . Two other sectors ( Ullevål , Norway , and Roskilde , Denmark ) are comparison sectors and rely on existing detection and referral systems for first-episode cases . The study ultimately will compare early detected with usual detected patients . This paper describes the study 's major independent intervention variable , i.e. a comprehensive education and detection system to change DUP in first onset psychosis . System variables and first results from the four-year inclusion period ( 1997 - 2000 ) are described . It includes targeted information towards the general public , health professionals and schools , and ED teams to recruit appropriate patients into treatment as soon as possible . This plus easy access to psychiatric services via ED teams systematic ally changed referral patterns of first-episode schizophrenia . DUP was reduced by 1.5 years ( mean ) from before the time the ED system was instituted ( to 0.5 years ) . The ED strategies appear to be effective and to influence directly the community 's help-seeking behaviour BACKGROUND There are few evaluations of strategies to improve rates of early detection and treatment of patients with first-episode psychosis . AIMS To evaluate the effectiveness of a general practitioner ( GP ) education programme and an early detection assessment team ( the Lambeth Early Onset Crisis Assessment Team ; LEO CAT ) in reducing delays in accessing treatment for first-episode psychosis patients . METHOD 46 clusters of GP practice s r and omised to GP education in early detection with direct access to LEO CAT v. care as usual . Primary outcome measures were GP referral rates , duration of untreated psychosis ( DUP ) and delays in receiving treatment . RESULTS 150 patients with first-episode psychosis were recruited ; 113 were registered with the study GPs , who referred 54 ( 47.7 % ) directly to mental health services . Significantly more intervention group GPs ( 86.1 % v. 65.7 % ) referred their patients directly to mental health services and fewer patients experienced long delays in receiving treatment . However , their overall DUP was unaffected . CONCLUSIONS Educating GPs improves detection and referral rates of first-episode psychosis patients . An early detection team reduces the long delays in initial assessment and treatment . However , these only impact on the later phases of the DUP . Broader measures , such as public health education , are needed to reduce the earlier delays in DUP Background The Mental Health First Aid training course was favorably evaluated in an uncontrolled trial in 2002 showing improvements in participants ' mental health literacy , including knowledge , stigmatizing attitudes , confidence and help provided to others . This article reports the first r and omized controlled trial of this course . Methods Data are reported on 301 participants r and omized to either participate immediately in a course or to be wait-listed for 5 months before undertaking the training . The participants were employees in two large government departments in Canberra , Australia , where the courses were conducted during participants ' work time . Data were analyzed according to an intention-to-treat approach . Results The trial found a number of benefits from this training course , including greater confidence in providing help to others , greater likelihood of advising people to seek professional help , improved concordance with health professionals about treatments , and decreased stigmatizing attitudes . An additional unexpected but exciting finding was an improvement in the mental health of the participants themselves . Conclusions The Mental Health First Aid training has shown itself to be not only an effective way to improve participants ' mental health literacy but also to improve their own mental health . It is a course that has high applicability across the community CONTEXT Most studies on first-episode psychosis show an association between a long duration of untreated psychosis ( DUP ) and poorer short-term outcome , but the mechanisms of this relationship are poorly understood . OBJECTIVE To determine whether it is possible to reduce the DUP for first-episode patients in a defined health care area through the introduction of an early detection ( ED ) program , compared with parallel health care areas without an ED program ( No-ED ) . SETTING AND PATIENTS We included consecutive patients with a DSM-IV diagnosis of nonorganic , nonaffective psychosis coming to their first treatment in the study health care areas between January 1 , 1997 , and December 31 , 2000 . A total of 281 patients ( 76 % of the total ) gave informed consent . INTERVENTIONS The ED and No-ED health care areas offered an equivalent assessment and treatment program for first-episode psychosis . The ED area also carried out an intensive ED program . RESULTS The DUP was significantly shorter for the group of patients coming from the ED area , compared with patients from the No-ED areas ( median , 5 weeks [ range , 0 - 1196 weeks ] vs 16 weeks [ range , 0 - 966 weeks ] ) . Clinical status measured by the Positive and Negative Syndrome Scale and the Global Assessment of Functioning Scale was significantly better for patients from the ED area at start of treatment and , with the exception of Positive and Negative Syndrome Scale positive subscale , at 3 months . Multiple linear regression analyses gave no indication that confounders were responsible for these differences . CONCLUSIONS It is possible to reduce the DUP through an ED program . The reduction in DUP is associated with better clinical status at baseline that is maintained after 3 months This study evaluates the ability of a safer sex televised public service announcement ( PSA ) campaign to increase safer sexual behavior among at-risk young adults . Independent , monthly r and om sample s of 100 individuals were surveyed in each city for 21 months as part of an interrupted-time-series design with a control community . The 3-month high-audience-saturation campaign took place in Lexington , KY , with Knoxville , TN , as a comparison city . Messages were especially design ed and selected for the target audience ( those above the median on a composite sensation-seeking/impulsive-decision-making scale ) . Data indicate high campaign exposure among the target audience , with 85%-96 % reporting viewing one or more PSAs . Analyses indicate significant 5-month increases in condom use , condom-use self-efficacy , and behavioral intentions among the target group in the campaign city with no changes in the comparison city . The results suggest that a carefully targeted , intensive mass media campaign using televised PSAs can change safer sexual behaviors BACKGROUND Delays in accessing care for young people with a first episode of psychosis are significantly associated with poorer treatment response and higher relapse rates . AIM To assess the effect of an educational intervention for GPs on referral rates to early-intervention services and the duration of untreated psychosis for young people with first-episode psychosis . DESIGN OF STUDY Stratified cluster r and omised controlled trial , clustered at practice level . SETTING Birmingham , Engl and . METHOD Practice s with access to the three early-intervention services in three inner-city primary care trusts in Birmingham were eligible for inclusion . Intervention practice s received an educational intervention addressing GP knowledge , skills , and attitudes about first-episode psychosis . The primary outcome was the difference in the number of referrals to early-intervention services between practice s. Secondary outcomes were duration of untreated psychosis , time to recovery , use of the Mental Health Act , and GP consultation rate during the developing illness . RESULTS A total of 110 of 135 eligible practice s ( 81 % ) were recruited ; 179 young people were referred , 97 from intervention and 82 from control practice s. The relative risk of referral was not significant : 1.20 ( 95 % confidence interval [ CI ] = 0.74 to 1.95 ; P = 0.48 ) . No effect was observed on secondary outcomes except for ' delay in reaching early-intervention services ' , which was statistically significantly shorter in patients registered in intervention practice s ( 95 % CI = 83.5 to 360.5 ; P = 0.002 ) . CONCLUSION GP training on first-episode psychosis is insufficient to alter referral rates to early-intervention services or reduce the duration of untreated psychosis ; however , there is a suggestion that training facilitates access to the new specialist teams for early psychosis R and omised controlled trials are widely accepted as the most reliable method of determining effectiveness , but most trials have evaluated the effects of a single intervention such as a drug . Recognition is increasing that other , non-pharmacological interventions should also be rigorously evaluated.1 - 3 This paper examines the design and execution of research required to address the additional problems result ing from evaluation of complex interventions —that is , those “ made up of various interconnecting parts.”4 The issues dealt with are discussed in a longer Medical Research Council paper ( www.mrc.ac.uk/complex_packages.html ) . We focus on r and omised trials but believe that this approach could be adapted to other design s when they are more appropriate . # # # # Summary points Complex interventions are those that include several components The evaluation of complex interventions is difficult because of problems of developing , identifying , documenting , and reproducing the intervention A phased approach to the development and evaluation of complex interventions is proposed to help research ers define clearly where they are in the research process Evaluation of complex interventions requires use of qualitative and quantitative evidence There are specific difficulties in defining , developing , documenting , and reproducing complex interventions that are subject to more variation than a drug . A typical example would be the design of a trial to evaluate the  benefits of specialist stroke units .  Such a trial would have to consider the expertise of various health professionals as well as investigations , drugs , treatment guidelines , and arrangements for discharge and follow up . Stroke units may also vary in terms of organisation , management , and skill mix . The active components of the stroke unit may be difficult to specify , making it difficult to replicate the intervention . The box gives other examples of complex interventions . # # # # Examples of complex interventions Service delivery and organisation : Stroke units Hospital at home Interventions directed at health professionals ' behaviour : Strategies for implementing guidelines Computerised decision support Community interventions : Community 
    Output:
    
Evidence suggests that general practitioner education campaigns and dedicated early intervention services do not by themselves reduce DUP or generate more treated cases .
Evidence for multifocus initiatives is mixed : intensive campaigns targeting the general public as well as relevant professionals may be needed .
CONCLUSIONS How early detection can be achieved is not clear .