Overcoming the effect of pandemic fatigue on vaccine hesitancy-Will belief in science triumph?

PURPOSE: The study aims to examine the factors that impact vaccination uptake and additional protective behavior during the fourth wave of the pandemic in Israel, whereas the "pandemic fatigue" phenomenon has been identified as a hurdle to adherence to protective health behaviors against coronavirus disease 2019 (COVID-19). DESIGN: A cross-sectional, structured questionnaire was utilized for this investigation in September 2021, during the fourth wave of the pandemic. METHODS: A sample of the adult (18+) Israeli population was employed for the study. Recruiting participants for the study was conducted through an online internet panel company that consists of over 100,000 members, representing all geographic and demographic sectors of the Israeli population. RESULTS: Our findings indicate that pandemic fatigue has begun to have cascading effects on vaccination efforts. In particular, this study found that at this stage of the COVID-19 pandemic, trust in authorities, and even threat perception components, such as concern and fear of contracting the disease, are incapable of predicting vaccination uptake. Instead, perception of the importance of the vaccine and its effectiveness are predictive of vaccination uptake. CONCLUSION: The findings indicate that at this stage of the pandemic, focusing on the robustness of the science behind the vaccine is more important than trying to regain public trust. The findings also suggest that risk communication employing fear tactics is losing its capacity to generate motivation for vaccination. CLINICAL RELEVANCE: The findings of this study reveal lessons learned from the COVID-19 global pandemic. Specifically, the study reveals how in times of prolonged crisis, we can currently and, in the future, prepare improved strategies for public communication in order to promote uptake of protective health behavior, such as vaccination.

Do we cope similarly with different adversities? COVID-19 versus armed conflict.

BACKGROUND: Varied populations may react differently to similar crises, depending on their social, cultural, and personal backgrounds; conversely, the same populations may respond differently to varied adversities. The current study aimed to examine three types of resilience (individual, community, and societal resilience) predicting six coping mechanisms (sense of danger, anxiety and depressive symptoms, well-being, hope, and morale) among the same sample of people that faced across two different adversities-COVID-19 and an armed conflict. METHODS: Two repeated measurements of the same Israeli sample (N = 593) were employed, through an internet panel. The research variables were examined through a structured, quantitative questionnaire that consisted of nine scales, based on validated and reliable questionnaires. RESULTS: Results indicated that: (a) respondents reported more difficulties in coping with the COVID-19 crisis, compared to the armed conflict, in all variables but morale. (b) similar patterns of correlations among the study variables were found in both measurements. (c) path's analysis indicated similar patterns of prediction of distress and well-being by individual and societal resilience. Use of the coping mechanism varied depending on the perception of the threat: COVID -19 is perceived as a less familiar and predictable adversity, which is harder to cope with, compared with the more familiar risk - an armed conflict, which is a recurrent threat in Israel. The correlations between the investigated psychological responses and the impacts of resilience on the coping and distress mechanism were similar in both adversities. CONCLUSIONS: The results indicate that respondents tend to react in a similar pattern of associations among resilience, distress, and well-being across different adversities, such as COVID and armed conflict. However, individuals tend to regard unfamiliar, less predictable adversities as more complex to cope with, compared to better-known crises. Furthermore, respondents tend to underestimate the risks of potential familiar adversities. Healthcare professionals must be aware of and understand the coping mechanisms of individuals during adversities, to appropriately design policies for the provision of medical and psychological care during varied emergencies.

Physician and nurses' perception of paediatric trauma care in Israeli emergency departments.

BACKGROUND: Treatment of paediatric trauma requires specialized infrastructure, medical equipment, medical staff and ancillary support personnel that have been specifically trained for such tasks. AIMS AND OBJECTIVES: To examine the perceptions and attitudes of physicians and nurses in general and paediatric emergency departments (PEDs) on training, confidence, and management of paediatric trauma in order to facilitate the establishment of an optimal model for admitting and treating paediatric trauma patients. DESIGN: Drawing on published literature and a previously conducted qualitative study that explored the provision of medical care to paediatric trauma patients, we conducted an attitude survey. METHODS: A 26-item paper-based questionnaire was distributed by nurse managers to all staff working within general EDs and PEDs of 22 medical centres across Israel. RESULTS: Of 843 physicians and nurses who completed the survey, 61.1% considered PEDs the most appropriate facility for treating both minor and severe paediatric trauma, 88.5% believed that minor paediatric trauma should be treated in designated paediatric trauma centres, and 53.6% deemed that paediatric emergency medicine specialists are the most suitable primary decision makers in paediatric trauma. PED teams expressed greater professional confidence for treating paediatric trauma and multiple casualty incident patients. Greater professional confidence was positively correlated with paediatric trauma training, greater exposure to paediatric trauma cases, and working in larger medical centres. CONCLUSIONS: The results of the current study suggest that PEDs are perceived to be more appropriate for dealing with paediatric trauma. Also, treatment of severe trauma may be more appropriate in centres that admit large numbers of paediatric trauma cases. RELEVANCE TO CLINICAL PRACTICE: Emergency medicine teams should undergo training for dealing with paediatric trauma. Such training would develop their skills, increase their confidence, and enhance their emotional abilities to cope with paediatric trauma.

Heatwave-protective knowledge and behaviour among urban populations: a multi-country study in Tunisia, Georgia and Israel.

BACKGROUND: There is an expected increase in heatwaves globally. As such, it is imperative to have sufficient levels of heatwave-protective knowledge and behaviour in areas regularly affected by heatwaves. Our study assessed this among urban populations in Tunisia, Georgia and Israel. METHODS: We undertook a cross-sectional population survey in the three countries. The questionnaire focused on obtaining information on respondents' knowledge level regarding 1) symptoms due to overheating, 2) risk groups for heatwaves, 3) actions to take when someone is overheated, and 4) heatwave-protective measures. Furthermore, we asked respondents about protective measures they applied during the last heatwave. We compared the results between the countries. RESULTS: Heatwave-protective knowledge was highest in Israel, and lowest in Georgia, for all indicators except for heatwave-protective measures, for which knowledge was highest in Tunisia. Most respondents who named certain protective measures had also applied these during the last heatwave: more than 90% for all measures except for one in Tunisia and Israel, and more than 80% for all measures in Georgia. CONCLUSION: There is a need to further improve heatwave-protective knowledge in Tunisia, Georgia and Israel. One potential solution to achieve this is by implementing a National Heat Health Action Plan. Improving knowledge is a vital step before adaptive behaviour can take place.

Differences in levels of psychological distress, perceived safety, trust, and efficacy amongst hospital personnel during the COVID-19 pandemic.

The COVID-19 pandemic poses significant challenges to healthcare systems worldwide. A key consideration is the adverse psychological impact on healthcare workers (HCWs). This study aimed to investigate the variable levels of psychological distress, perceived safety, trust, and self- and collective-efficacy during the COVID-19 crisis amongst varied HCWs. A survey was disseminated to nurses, physicians, interns, and administrative and logistical staff at an acute-care hospital in Israel during the first wave of COVID-19. The survey consisted of items on a 5-point Likert scale, measuring HCW's perceptions concerning the aforementioned variables as well as demographic information. A total of 716 hospital personnel completed the survey. Nurses reported higher levels of psychological distress and lower levels of trust in the hospital's COVID-19 guidelines compared to physicians (2.3 vs. 2.0 and 3.7 vs. 4.0, respectively). Nurses and interns felt the least safe when working in the hospital. Nurses reported the highest levels of concern regarding fear of uncontrollable spread, infection, and family transmission of the virus. Interns reported the lowest levels of self- and collective-efficacy. In a regression model, the variables that predicted 32% of distress among nurses were age, gender, level of religiosity, indices of perceived safety, and self-efficacy. This study demonstrated differences in distress and perceived safety, trust, and efficacy between varied HCWs during COVID-19. This variability should be considered when designing policies to protect HCWs' wellbeing during future pandemics.

Reconsidering policy of casualty evacuation in a remote mass-casualty incident.

OBJECTIVES: Inappropriate distribution of casualties in mass-casualty incidents (MCIs) may overwhelm hospitals. This study aimed to review the consequences of evacuating casualties from a bus accident to a single peripheral hospital and lessons learned regarding policy of casualty evacuation. METHODS: Medical records of all casualties relating to evacuation times, injury severity, diagnoses, treatments, resources utilized and outcomes were independently reviewed by two senior trauma surgeons. In addition, four senior trauma surgeons reviewed impact of treatment provided on patient outcomes. They reviewed the times for the primary and secondary evacuation, injury severity, diagnoses, surgical treatments, resources utilized, and the final outcomes of the patients at the point of discharge from the tertiary care hospital. RESULTS: Thirty-one survivors were transferred to the closest local hospital; four died en route to hospital or within 30 minutes of arrival. Twenty-seven casualties were evacuated by air from the local hospital within 2.5 to 6.15 hours to Level I and II hospitals. Undertriage of 15% and overtriage of seven percent were noted. Four casualties did not receive treatment that might have improved their condition at the local hospital. CONCLUSIONS: In MCIs occurring in remote areas, policy makers should consider revising the current evacuation plan so that only immediate unstable casualties should be transferred to the closest primary hospital. On site Advanced Life Support (ALS) should be administered to non-severe casualties until they can be evacuated directly to tertiary care hospitals. First responders must be trained to provide ALS to non-severe casualties until evacuation resources are available.

Perceived functional resilience in schools according to key stakeholders.

Amid the COVID-19 outbreak, Israel and numerous other governments closed schools as a precaution, leading to a sudden shift to online learning. The aim of the current study is to provide foundational insight into the perceived readiness of the school system to withstand future adversities, based on the challenges, complexities, as well as successes in adaptation faced by stakeholders during COVID-19. In this cross-sectional study, we assess the perceived levels of functional resilience of the school system among the key stakeholders of the Israeli education system-high school students, parents, teachers, and principals, as well as a composite functional resilience scale. The composite functional resilience consists of 10 main indexes: communication during distance learning (DL) and frontal learning (FL); Perceived stress scale-4 (PSS); psychosocial aspects during distance learning (DL) and frontal learning (FL); digital literacy; pedagogic support; resources; infrastructure; and distance versus frontal learning. The study findings demonstrate differences according to the stakeholders with regard to the perceived functional resilience and the composite functional resilience scores (e.g., students with respect to both of these scores exhibit the lowest results, while teachers display the highest scores). Furthermore, no one variable was significant across the board for all stakeholders in predicting the perceived functional resilience, with the most common predictors among the stakeholders being digital literacy, pedagogic support, PSS, as well as communication during distance and frontal learning. The findings of this study reveal areas for recommended priority actions to be conducted among school system stakeholders.

Unveiling factors shaping distress levels over 2.5 years of enduring adversity.

In the face of global adversities such as pandemics, military conflicts, and socio-political unrest, the resilience and well-being of populations can be severely tested. This study examines the fluctuating levels of distress within the Israeli population over a period of 2.5 years, encompassing events like the COVID-19 pandemic and various socio-political and security crises. Utilizing a quasi-longitudinal design, data were collected at thirteen time-points, mirroring the demographic makeup of the Israeli Jewish adult population. Measures of psychological distress, societal and individual resilience, hope, morale, and perceived danger were assessed, alongside demographic variables. Statistical analyses included ANOVA and stepwise regression models. Distress levels displayed significant oscillations in response to adverse events. High distress was noted during the latter stages of the study, particularly following a major security incident on October 7, 2023. The regression analyses identified morale and perceived danger as consistent important associations with distress, with individual resilience also inversely related across all time points. The study reveals the dynamic nature of psychological distress in relation to a range of adversities. Morale emerged as a key buffer against distress, whereas perceived danger was a significant stressor, especially during acute- existential threats. These findings have important implications for mental health interventions and policy-making aimed at fostering resilience and mitigating distress in crisis conditions.

A longitudinal study of societal resilience and its predictors during the Israel-Gaza war.

This study assesses the resilience of Israeli society during the ongoing Israel-Gaza conflict and pinpoints factors that influence this resilience in prolonged national crises. A longitudinal study was carried out with two surveys, both using the same questionnaire to gage societal, community, and individual resilience levels, along with hope, morale, distress, perceived threats, and government support. The initial survey was administered 5 days after the war escalated and the second 1 month later. The study's results reveal a decline in societal resilience over time. The regression analysis identified four major associations at both resilience measurement points. The key variables are community resilience and hope, both contributing positively. Attitudes towards government support (specifically being a government supporter vs. an opponent) also played a role. Additionally, there was a negative association with levels of religiosity, particularly distinguishing between ultra-orthodox and secular individuals. In the temporal analysis predicting future resilience (from data at the first time point to predict resilience at the second time point), societal resilience at the first measurement was the strongest forecaster of its resilience at the second measurement. Additionally, the main continuous variable from the previous analysis, community resilience, continued to be an influential and positive forecaster in the time-based analysis. The research suggests that the initial unifying effect of the conflict, similar to a "Rally around the flag" phenomenon, may be short-lived. The study underlines the importance of community strength, hope, government support, and religious considerations in shaping societal resilience in the face of conflict.

Perspective: lessons learned from the COVID-19 pandemic concerning the resilience of the population.

BACKGROUND: A vital stakeholder in the successful management of the COVID-19 pandemic is the public. The degree of involvement of the population in managing the pandemic, and the leadership perception of the public, had a direct impact on the resilience of the population and level of adherence to the issued protective measures. MAIN BODY: Resilience refers to the ability to 'bounce back' or 'bounce forward' following adversity. Resilience facilitates community engagement which is a crucial component of combating the COVID-19 pandemic. The article highlights six insights recognized in studies conducted in Israel during and following the pandemic concerning the resilience of the country's population. (1) Contrary to varied adversities in which the community serves as an important support system to the individuals, this type of support was substantially impaired during the COVID-19 pandemic, due to the need to maintain isolation, social distancing, and lockdowns. (2) Policy-making during the pandemic should be based on evidence-based data, rather than on assumptions made by decision-makers. This gap led the authorities during the pandemic to adopt measures that were ineffective, such as risk communication based on 'scare tactics' concerning the virus, when the highest risk perceived by the public was political instability. (3) Societal resilience is associated with the public's behavior, such as with vaccine hesitancy and uptake. (4) Factors that affect the levels of resilience include, among others, self-efficacy (impacts individual resilience); social, institutional, and economic aspects as well as well-being (impact community resilience); and hope and trust in the leadership (impact societal resilience). (5) The public should be perceived as an asset in managing the pandemic, thus becoming a vital part of the 'solution'. This will lead to a better understanding of the needs and expectations of the population and an applicable 'tailoring' of the messages that address the public. (6) The gap between science and policymaking must be bridged, to achieve optimal management of the pandemic. CONCLUSIONS: Improving preparedness for future pandemics should be based on a holistic view of all stakeholders, including the public as a valued partner, connectivity between policymakers and scientists, and strengthening the public's resilience, by enhancing trust in authorities.

Impact of the war in Ukraine on resilience, protective, and vulnerability factors.

War or armed conflict is one of the most severe human-made adversities. The current study examines the resilience, protective, and vulnerability factors of a sample of Ukrainian civilians, during the current Russian-Ukrainian war. The level of resilience and coping indicators were compared with the responses of an Israeli sample following an armed conflict in May 2021. The data were collected by an internet panel company. A representative sample of Ukrainian residents (N = 1,001) responded to an online questionnaire. A stratified sampling method was employed regarding geographic distribution, gender, and age. The data concerning the Israeli population (N = 647) were also collected by an internet panel company during a recent armed conflict with Gaza (May 2021). Three notable results emerged in this study: (a) The Ukrainian sample reported significantly higher levels of the following: Distress symptoms, sense of danger, and perceived threats, compared with the Israeli sample. However, despite these harsh feelings, the Ukrainian respondents reported substantially higher levels of hope and societal resilience compared, to their Israeli counterparts, and somewhat higher individual and community resilience. (b) The protective factors of the respondents in Ukraine (level of hope, wellbeing, and morale), predicted the three types of resilience (individual, community, and social) better than the vulnerability factors (sense of danger, distress symptoms, and level of threats). (c) The best predictors of the three types of resilience were hope and wellbeing. (d) The demographic characteristics of the Ukrainian respondents hardly added to the prediction of the three types of resilience. It appears that a war that threatens the independence and sovereignty of a country may, under certain conditions, enhance the societal resilience and hope of the population under risk, despite a lower sense of wellbeing and higher levels of distress, sense of danger, and perceived threats.

Predictors of PTSD and Psychological Distress Symptoms of Ukraine Civilians During war.

OBJECTIVE: War may raise the level of distress and post-traumatic stress disorder (PTSD). The study explores the extent to which 4 factors determine levels of PTSD and distress symptoms of Ukraine civilians (without developing PTSD) during the current war. METHOD: The data were collected via a Ukrainian internet panel company. 1001 participants responded to a structured online questionnaire. Path analysis was conducted to identify predictive indicators of PTSD scores. RESULTS: PTSD symptoms positively correlated with respondents' level of exposure to the war and their sense of danger, and negatively correlated with well-being, family income, and age. Females scored higher on PTSD symptoms. Path analysis showed that higher exposure to war and higher sense of danger increase PTSD and distress symptoms, whereas higher well-being, higher individual resilience, and being a man, as well as older age decrease their level. Despite the strong effects of the coping suppressing factors, most respondents did not reach the critical level of PTSD or distress symptoms. CONCLUSION: At least 4 positive and negative factors account for people's coping with stressful experiences: previous traumatic experiences, individual level of pathology, personality attributes, and socio-demographic characteristics. The balance of these factors protects most people from PTSD symptoms despite their being affected by war traumas.

Burnout and resilience at work among health professionals serving in tertiary hospitals, in Ethiopia.

Background: The quality of healthcare service is strongly affected by the health professionals' levels of burnout and resilience at work (RaW). Developing resilience is a key component of medical professionalism. Although burnout and resilience are indicators used to assess the level of workplace hardship, there is a dearth of information in most developing countries, including Ethiopia. Objective: To assess the levels of burnout and 'resilience at work' among health professionals who work in the surgical care departments in teaching Ethiopian hospitals. Methods: A cross-sectional study design was applied among health professionals employed in surgical, gynecologic, and obstetric (Gyn/Obs) departments of two acute-care hospitals (n = 388). A structured self-administered English version questionnaire, consisting of validated scales to measure RaW and burnout, was used to collect the data;22 items of Maslach's burnout inventory human service survey tool and 20 items of Win wood's resilience at work' measuring tool" was employed to assess the health professionals' burnout level and Resilience at work, respectively. Linear logistics regression was employed for inferential statistical analysis to identify factors that predict RaW and burnout. Results: Burnout syndrome was shown among 101 (26.0%) study participants. Furthermore, 205 (52.8%), 150 (38.7%), and 125 (32.2%) participants presented high emotional exhaustion, high depersonalization, and low personal accomplishment, respectively. Emotional exhaustion was predicted by the participants' profession, the hope of promotion, professional recognition, and workload. Depersonalization was predicted by age, profession, and perceived workload of the participants. The predictors for personal accomplishment were profession, relationship at work, professional recognition, and having a managerial position in addition to clinical duty. The participants' mean RaW score was 78.36 (Standard deviation ±17.78). A negative association was found between RaW and emotional exhaustion and depersonalization. In contrast, a positive association was identified between RaW and personal accomplishment. The type of profession and marital status were positive predictors of RaW. Conclusion: A substantial amount of health professionals experience high burnout in one or more burnout dimensions. Level of RaW is more affected by burnout syndrome. Therefore, promoting activities that increase the level of professional RaW and recognition in their professional practice is needed to reduce job burnout. These findings are especially important concerning low socio-economic countries, as resilience is a vital component of the development of healthcare systems.

Demographic factors, partial social belonging and psychological resources associated with coping.

Introduction: The present study investigates the role of perceived partial social belonging (PPSB) in determining societal and individual resilience and positive and negative coping indicators. It is assumed that most people aspire to belong and be integrated into their society. A sense of only partial belonging is therefore distressing for them. Methods: Two hypotheses are examined in the current study: (a) A higher level of PPSB will predict a lower level of resilience and a higher level of psychological symptoms. (b) PPSB will mediate the associations between three stress-evoking demographic characteristics (younger age, low income, and gender) and the lower psychological resilience and higher distress associated with these demographic characteristics. These hypotheses were examined using a sample of the Israeli Jewish public (N = 1,502) who responded to an anonymous questionnaire about the investigated issues. The data were collected by an internet panel company possessing a database of more than 65,000 residents, representing the varied components of the Israeli society. Results: The findings supported our hypotheses: (a) PPSB negatively predicted societal and individual resilience and hope and positively predicted distress symptoms and sense of danger. (b) PPSB mediated the effects of the investigated demographic variables on these psychological variables. Conclusion: These results are discussed in association with the concept of belonging competencies. Our findings display that being unsure about one's belonging to a desired social group, has a major role in increasing psychological distress and sense of danger and in reducing hope and both individual and societal resilience.

Distress following the COVID-19 Pandemic among Schools' Stakeholders: Psychosocial Aspects and Communication.

In response to the COVID-19 pandemic, many governments ordered school closures as a containment measure, with Israel being among over 100 countries to do so. This resulted in the abrupt shift to online and remote education for many students. Despite attempts to minimize the effects of disrupted education and create a dynamic virtual learning environment, the literature highlights various challenges including lack of communication with implications of distress faced by key stakeholders (students and their parents, teachers, and principals). In this cross-sectional study, we assess the perceived levels of communication and psychosocial aspects during both distance and frontal learning, as well as the long-term impacts (following over two and a half years of an ongoing pandemic) on distress among the key stakeholders of the Israeli education system- high school students, parents, teachers, and principals. The study findings demonstrate severe implications of distance learning on communication and psychosocial aspects, with lingering long-term impacts on distress, among all stakeholders (particularly among students). This reveals the need for tailored capacity building and resilience intervention programs to be integrated in the long-term response to the current ongoing pandemic to improve well-being and reduce distress among the various stakeholders, with particular attention to those that are most vulnerable and were hit the hardest.

An innovative tool to assess the functional resilience of a school system: learning from the COVID-19 pandemic.

Introduction: Preparing the school system for a future crisis requires the ability to examine the effectiveness of schools' functioning during distant learning and their level of preparedness for future crises. Functional resilience (FR) is defined as the ability to maintain vital operational continuity in the face of disturbance. The study objectives included to develop a FR index of schools and to evaluate and validate it. Methods: To enable examination of the study objectives, the study design included tool development, followed by a validation process among 20 content experts. Concurrently, an eDelphi process for building an inclusive index, based on various components of resilience was conducted. The final study tool consists of four tailored questionnaires to examine perceptions of key stakeholders, i.e.- teachers, principals, parents, and highschool students regarding communication, psychosocial aspects, perceived stress, infrastructure, resources, pedagogic support, digital literacy, and perceived FR. Using an internet panel, the tool was disseminated cross-sectionally among the four groups of stakeholders. Results: The results showed high reliability of most of the scales developed. Furthermore, a high consensus level was reached on the relative importance of each component/ stakeholder to the schools FR. The findings further suggest that there were no significant differences in the composite FR score based on characteristics such as school type/ size/geographic location. However, the findings revealed interesting variations among stakeholders, with findings suggesting greater vulnerability among some. Discussion: To increase resilience and preparedness for future adversities that school systems may face, it is recommended to periodically incorporate an assessment based on a structured tool.

Do first responders and populations perceive risks similarly? A comparative study of seven countries.

Introduction: Risk perception illustrates the subjective evaluation of individuals concerning the characteristics, severity, and capacity to cope with potential hazards. Risk perception influences attitudes and actions individuals take to protect themselves from future threats. Risk perceptions might change among different stakeholder groups such as society and first responders. Identifying risk perceptions of stakeholders is essential to establish effective protective measures. Method: This study investigated the commonalities and diversities in risk perception among first responders and the public, within and between seven European and beyond countries. A self-administered questionnaire was used to gather data from both first responders and civilians. They were asked to assess their risk perception level for five categories of risks (Extreme weather-related events, nature-related events, social disruptions, critical services dependencies, and pandemics). Results: Using Univariate Analysis of Variance showed disparity concerning both the levels of risk perception between the public and first responders, as well as their relative ranking. For example, concerning extreme weather-related and nature-related events, risk perception levels of the first responders is higher than that of the population in six out of the seven studied countries. In contrast, the population's risk perception is higher compared to the first responders in six out of the seven countries, concerning critical infrastructure dependencies and pandemics. Discussion: The relative gaps between the first responders versus the population, within each country, vary considerably. Norway for example presents significant differences between the two internal populations concerning all risks (except for extreme weather), while in Sweden, no significant gaps were identified, concerning all five risks.

A full-scale Russian invasion of Ukraine in 2022: Resilience and coping within and beyond Ukraine.

The study examined the resilience and coping of samples from Ukraine and five nearby countries during the war in Ukraine. The research focused on (1) the levels of community and societal resilience of the Ukrainian respondents compared with the populations of five nearby European countries and (2) commonalities and diversities concerning coping indicators (hope, well-being, perceived threats, distress symptoms, and sense of danger) across the examined countries. A cross-sectional study was conducted, based on data collection through Internet panel samples, representing the six countries' adult populations. Ukrainian respondents reported the highest levels of community and societal resilience, hope, and distress symptoms and the lowest level of well-being, compared to the population of the five nearby European countries. Hope was the best predictor of community and societal resilience in all countries. Positive coping variables, most notably hope, but also perceived well-being are instrumental in building resilience. While building resilience on a societal level is a complex, multifaceted task, various dimensions must be considered when planning actions to support these states. It is essential to monitor the levels of resilience, during and following the resolution of the crisis, both in Ukraine and in the neighboring countries.

Involvement of surgical residents in the management of trauma patients in the emergency room: does the presence of an attending physician affect outcomes?

BACKGROUND: Few studies have investigated whether the presence or absence of attending physicians (AP) in the emergency department (ED) during the management of trauma patients by residents. METHODS: Six level 1 trauma center admissions for years 2006-2008 were analyzed to determine whether presence of an AP affected the time spent in the ED, post-ED disposition, and in-hospital mortality. RESULTS: Patient demographics differed in relation to the presence of APs (P < 0.01). Patients with ISS > 25 who died during hospitalization were more often managed when APs were present. Male patients, those <65, and patients with Injury Severity Score (ISS) > 16 were more often treated in the presence of an AP (P < 0.01). Penetrating, terror trauma, motor vehicle collision and assaults were more often managed in the presence APs. Presence of APs differed by hospital (P < 0.0001). Adjusted logistic regression revealed that patients spent less time in the ED, went directly to the operating room or the ICU for definitive care, if an AP was present. CONCLUSIONS: Presence of an attending physician improved and focused patient triage, disposition decisions, and outcomes.