Cannabis-related information sources among US residents: A probability-weighted nationally representative survey.

INTRODUCTION: The Department of Health and Human Services recently recommended rescheduling cannabis from Schedule I to Schedule III, which might have broad effects on public health outcomes related to cannabis. In this changing environment, understanding national patterns in how people obtain information about cannabis is critical to informing public health outreach and education. METHODS: We surveyed American adults (≥ 18 years) between June 22nd-26th, 2023 using the AmeriSpeak panel. We assessed past year cannabis use, intentions for cannabis use, and where participants got their information about cannabis. We investigated differences by past year use and explored associations between demographic and cannabis use characteristics with information sources using logistic regression. RESULTS: Participants (n = 1,161) were 48.3±27.3 years of age (mean±standard deviation), 51% female, and 27% reported past year cannabis use. The most common information sources used were friends/family (35.6%) and websites (33.7%), while the least common information sources were health/medical care providers (9.3%), employees at place of purchase (8.6%), and government agencies (4.7%). Past year cannabis use was positively associated with all information sources except government agencies and popular media articles. A higher proportion of those using cannabis medically (with or without recreational use) obtained information from a healthcare provider (16.4% vs. 5.2%, p = 0.006). CONCLUSIONS: As cannabis accessibility increases and legality continues changing, there is a strong need for better clinician education, improved public health outreach, and improved communication between patients and clinicians about cannabis.

Prevalence and correlates of disordered eating at a large state university before and after the onset of the COVID-19 pandemic.

BACKGROUND: Emerging adulthood is a transitory period in which disordered eating (DE) manifests; collecting data on the prevalence of DE among this population as well as demographic and behavioral correlates are important public health goals. METHODS: Data from an annual survey of undergraduate students at a large state university from 2019 to 2022 were analyzed, allowing researchers to compare prevalence and correlates before and after the onset of the COVID-19 pandemic using two brief screeners: the SCOFF and Eating Disorder Screener for Primary Care (ESP). We hypothesized that rates of DE would be greater after the onset of COVID-19 as compared to before. We also hypothesized that those identifying as women, reporting higher alcohol or drug use, and contemplating suicide would have greater odds of reporting symptoms consistent with DE. RESULTS: DE was significantly lower in pre-pandemic years compared to pandemic years: ESP pre = 38.01%(n = 704), pandemic = 48.79%(n = 645), p < 0.001; SCOFF pre = 22.82%(n = 422), pandemic = 31.46%(n = 414), p < 0.001. Logistic regressions showed women and students who contemplated suicide reported significantly greater DE, regardless of screener or time period. Inconsistent relationships were found between DE and current substance use. CONCLUSION: These findings may inform targeted interventions for those most vulnerable to disordered eating.

It is important to track the rates of disordered eating (DE) in vulnerable populations like emerging adults (those who are between the ages of 18 and 25). Many emerging adults attend college, and during this time DE may occur. The COVID-19 pandemic has led to situations, like being isolated from friends and family, that we assume could increase DE. To present data on the rates of DE before and after the start of COVID-19, researchers collected data on whether college students engaged in DE two years before the start of COVID-19 (2019, 2020) and two after COVID-19 (2021, 2022). They considered whether characteristics of the student, like whether they were a man or woman or their race, were related to DE. DE increased significantly after COVID-19. Using one questionnaire, DE was about 38% before COVID-19 and increased to nearly 50% after COVID-19. Across all four years, women and students who thought about suicide were more likely to report DE. It is important to direct resources to students who are experiencing DE ­ which we now know could be as many as 50%. DE contributes to health problems and can worsen over time, leading to a life-threatening eating disorder.

On the move: Influence of animal movements on count error during drone surveys.

The use of remote sensing to monitor animal populations has greatly expanded during the last decade. Drones (i.e., Unoccupied Aircraft Systems or UAS) provide a cost- and time-efficient remote sensing option to survey animals in various landscapes and sampling conditions. However, drone-based surveys may also introduce counting errors, especially when monitoring mobile animals. Using an agent-based model simulation approach, we evaluated the error associated with counting a single animal across various drone flight patterns under three animal movement strategies (random, directional persistence, and biased toward a resource) among five animal speeds (2, 4, 6, 8, 10 m/s). Flight patterns represented increasing spatial independence (ranging from lawnmower pattern with image overlap to systematic point counts). Simulation results indicated that flight pattern was the most important variable influencing count accuracy, followed by the type of animal movement pattern, and then animal speed. A  awnmower pattern with 0% overlap produced the most accurate count of a solitary, moving animal on a landscape (average count of 1.1 ± 0.6) regardless of the animal's movement pattern and speed. Image overlap flight patterns were more likely to result in multiple counts even when accounting for mosaicking. Based on our simulations, we recommend using a lawnmower pattern with 0% image overlap to minimize error and augment drone efficacy for animal surveys. Our work highlights the importance of understanding interactions between animal movements and drone survey design on count accuracy to inform the development of broad applications among diverse species and ecosystems.

Nothing personal, it's the organization! Links between organizational culture, workplace bullying, and affective commitment.

Extensive attention in organizational research has been dedicated to workplace bullying, primarily focusing on its frequency and impact on both the victim and the bully, emphasizing interpersonal dynamics. This study extends current research by shifting the focus to the organizational level, examining the relationship between organizational culture and affective commitment, mediated by workplace bullying. Utilizing data from two surveys (N = 650 in 2012 and N = 553 in 2017), the study reveals that dimensions of organizational culture, such as assertiveness, performance orientation, and ingroup collectivism significantly influence work-related workplace bullying. Performance orientation and assertiveness are positively associated with increased bullying, whereas ingroup collectivism serves as a deterrent. In turn, work-related bullying negatively impacts affective commitment, while a culture characterized by high ingroup collectivism not only links negatively with bullying but also links positively with affective commitment. This work is one of the first studies to investigate the interplay among several dimensions of organizational culture, workplace bullying, and affective commitment, underscoring the importance of supportive organizational cultures in fostering healthy work environments.

Assessment of Smoking Behaviour of Adolescents in Two Districts of Nepal and Implications of the MPOWER Policy Measures: A Mixed Method Study.

INTRODUCTION: Tobacco use is the single most preventable cause of death and disease worldwide. This study aimed to assess the smoking behaviour of adolescents in two districts of Nepal and examine the implications of the MPOWER policy on their smoking behaviour. METHODS: An explanatory, mixed-method study was conducted in two districts of Nepal. Qualitative in-depth interviews were conducted among nine participants aged 35-50, representatives of the Ministry of Health, academic institutions, and managers of organisations working in tobacco control, using snowball sampling method. A total of 306 students of age 13-15 years, from six government schools were recruited through simple random sampling method using an adapted version of the Global Youth Tobacco Survey (GYTS). Findings of the qualitative and quantitative study were explained for concurrence and relevance to present overall study findings. Ethical approval was received from the Nepal Health Research Council and Mahidol University. RESULTS: Findings from the survey reported that a total of 25 (8.10%) of respondents were smokers, from which 13 (4.20%) were current smokers and 12 (3.90%) were ever smokers. Socio-economic status played a crucial role in the smoking behaviour. Although the survey among adolescents indicated an awareness of the policies, there was a lack of cessation services, which was concurrent with the qualitative findings. The interviews recommended improvements in the implementation of policy ban on public smoking, taxation, and availability of cessation services. CONCLUSIONS: The MPOWER policies are not regulated strictly, especially in areas of the ban on public smoking, regulating the selling of cigarettes to adolescents <18 years, and availability of cessation services.

Wastewater-based epidemiology for COVID-19 surveillance and beyond: A survey.

The pandemic of COVID-19 has imposed tremendous pressure on public health systems and social economic ecosystems over the past years. To alleviate its social impact, it is important to proactively track the prevalence of COVID-19 within communities. The traditional way to estimate the disease prevalence is to estimate from reported clinical test data or surveys. However, the coverage of clinical tests is often limited and the tests can be labor-intensive, requires reliable and timely results, and consistent diagnostic and reporting criteria. Recent studies revealed that patients who are diagnosed with COVID-19 often undergo fecal shedding of SARS-CoV-2 virus into wastewater, which makes wastewater-based epidemiology for COVID-19 surveillance a promising approach to complement traditional clinical testing. In this paper, we survey the existing literature regarding wastewater-based epidemiology for COVID-19 surveillance and summarize the current advances in the area. Specifically, we have covered the key aspects of wastewater sampling, sample testing, and presented a comprehensive and organized summary of wastewater data analytical methods. Finally, we provide the open challenges on current wastewater-based COVID-19 surveillance studies, aiming to encourage new ideas to advance the development of effective wastewater-based surveillance systems for general infectious diseases.

Attitudes and practices of Australian healthcare and sports workers on the use of ankle supports for management and prevention of lateral ankle sprains: A cross-sectional survey.

OBJECTIVE: Explore attitudes and practices of Australian professionals using ankle taping or bracing for the management and prevention of lateral ankle sprains. DESIGN: Cross-sectional study. SETTING: Anonymous online survey. PARTICIPANTS: Australian healthcare or athletic workers, registered with an official governing body, involved in the management and/or prevention of lateral ankle sprains. MAIN OUTCOME MEASURES: Quantitative data was collected from 20 close-ended questions. Qualitative data from 14 open-ended questions were categorized into topics using inductive thematic analysis. Data was analysed using descriptive statistics and presented in figures and tabular format. RESULTS: A total 160 respondents answered the survey; the majority were podiatrists (42.5%), physiotherapists (23%), or sports/athletic trainers (13.8%). Ankle supports were overwhelmingly recommended and considered to be effective in the management (95% and 89% bracing and taping, respectively) and prevention (96% and 92% bracing and taping, respectively) of lateral ankle sprains. For management, semi-rigid brace with straps (26%) and figure eight taping technique (42%) were the most frequently used. For prevention, the most commonly used were soft brace with straps (30%) and the figure eight taping technique (37%). CONCLUSIONS: Australian professionals expressed a positive attitude towards using ankle supports in the management and prevention of lateral ankle sprains.

Public perceptions related to healthcare preparedness to anti-amyloid therapies for Alzheimer's Disease in Japan.

BACKGROUND: The approval of lecanemab, an anti-amyloid therapy for Alzheimer's disease (AD), necessitates addressing healthcare preparedness for disease-modifying treatment (DMT) to ensure appropriate, safe, and sustainable drug administration. Understanding public perceptions on this matter is crucial. We aimed to assess discrepancies and similarities in the perceptions of Japanese trial-ready cohort study ('J-TRC webstudy') participants and clinical specialists in the fields of dementia treatment and radiology, concerning affairs related to challenges in DMT preparedness. METHODS: This was a cross-sectional prospective observational study conducted in November-December 2023. The J-TRC webstudy participants were invited to participate in an online survey using Google Forms, and clinical specialists were invited to complete a mail-based survey. Main questionnaire items had been designed to be common in both surveys, and their responses were analyzed for participant attributes, interests, attitudes, expectations, and concerns about DMTs without specifying lecanemab. RESULTS: Responses were obtained from n = 2,050 J-TRC webstudy participants and n = 1,518 clinical specialists. Compared to specialists, more J-TRC respondents perceived the eligible proportion for DMT as smaller (59.1% versus 30.7%), perceived the eligible severity for DMT as more limited (58.0% versus 24.5%), and perceived the efficacy of DMT as slightly more encouraging (29.3% versus 34.8%). In terms of treatment prioritization, both J-TRC respondents and specialist respondents exhibited similar levels of acceptance for prioritizing patients to treat: e.g., approximately two-thirds endorsed patient prioritization under hypothetical resource constraints or other reasons. A medical rationale emerged as the most compelling reason for acceptance of patient prioritization across the surveys. In contrast, the need to address vulnerable populations was the reason that led to the least acceptance of prioritization, followed by economic considerations. CONCLUSIONS: Our findings offer valuable insights into the discrepancies in knowledge and perception between patients and healthcare providers. This could enhance the delivery of patient information in clinical settings and inform the discussion surrounding patient prioritization strategies.

Participation Preferences in Cognitive Treatments Among Youth With Mental Illness: Findings From the Your Mind, Your Choice Survey.

AIM: To explore the cognitive treatment preferences of young people with mental illness. METHODS: Two-hundred and fourteen people, aged 12-25 years, were surveyed about their treatment priorities. Participants were specifically asked how they might like to receive cognitive treatments and identify factors that might influence their decisions to participate. RESULTS: Over half of the participants indicated that they would like to receive treatment face-to-face, in a one-on-one setting, with a treatment focus on both deficits and strengths, or without involvement from friends or family when asked about each preference individually. However, only 11% of people wanted all four of these preferences combined. Treatment cost, effectiveness, therapeutic relationships, and accessibility were the most frequently identified factors that could influence perceived decisions to participate. CONCLUSIONS: The cognitive treatment preferences of young people are variable. Supports focusing on both cognitive strengths and deficits were a novel finding and warrants further attention within existing treatment frameworks.

Slower but deeper community change: Intrinsic dynamics regulate anthropogenic impacts on species temporal turnover.

Understanding the mechanisms behind biodiversity dynamics is central to assessing and forecasting anthropogenic impacts on ecological communities. However, the manner in which external environmental drivers act in concert with intrinsic ecological processes to influence local temporal turnover is currently largely unexplored. Here, we determine how human impacts affect multiple metrics of bird community turnover to establish the ecological mechanisms behind compositional change. We used US Breeding Bird Survey data to calculate transect-level rates of three measures of temporal species turnover: (1) "short-term" (initial rate of decline of Sørensen similarity), (2) "long-term" (asymptotic Sørensen similarity), and (3) "throughput" (overall species accumulation rate from species-time relationship exponents) over 2692 transects across 27 regional habitat types. We then hierarchically fit linear models to estimate the effect of anthropogenic impact on these turnover metrics, using the Human Modification Index proxy, while accounting for observed species richness, the size of the species pool, and annual environmental variability. We found broadly consistent impacts of increased anthropogenic pressures across diverse habitat types. The Human Modification Index was associated with greater turnover at long timescales, but marginally slower short-term turnover. The species "throughput" (accumulation rate) was not notably influenced. Examining anthropogenic impacts on different aspects of species turnover in combination allows greater ecological insight. Observed human impacts on short-term turnover were the opposite of existing expectations and suggest humans are disrupting the background turnover of these systems, rather than simply driving rapid directed turnover. The increased long-term turnover without concurrent increases in species accumulation implies human impacts lead to shifts in species occurrence frequency rather than simply greater arrival of "new" species. These results highlight the role of intrinsic dynamics and caution against simple interpretations of increased species turnover as reflections of environmental change.

Smoking cessation assistance among pneumologists and thoracic surgeons in Switzerland: a national survey.

Objective: Smoking, with a prevalence of about 25%-30% in Switzerland, is proven to cause major systemic, avoidable diseases including lung cancer, increasing societies morbidity and mortality. Diverse strong quitting smoking recommendations have been made available providing advice facilitating smoking cessation globally. In other European countries like Germany, clinical practice guidelines for smoking cessation services have been implemented. However, in Switzerland, there is still no national consensus on a comprehensive smoking cessation program for lung cancer patients nor on the adequate provider. Our primary aim was to assess the current status of smoking cessation practice among specialists, mainly involved in lung cancer care, in Switzerland in order to uncover potential shortcomings. Material and methods: A self-designed 14-items questionnaire, which was reviewed and approved by our working group consisting of pneumologists and thoracic surgeons, on demographics of the participants, the status of smoking cessation in Switzerland and specialists' opinion on smoking cessation was sent to thoracic surgeons and pneumologists between January 2024 and March 2024 via the commercially available platform www.surveymonkey.com. Data was collected and analysed with descriptive statistics. Results: Survey response rate was 22.25%. Smoking cessation was felt to positively affect long term survival and perioperative outcome in lung cancer surgery. While 33 (37.08%) physicians were offering smoking cessation themselves usually and always (35.96%), only 12 (13.48%) were always referring their patients for smoking cessation. Patient willingness was clearly identified as main factor for failure of cessation programs by 63 respondents (70.79%). Pneumologists were deemed to be the most adequate specialist to offer smoking cessation (49.44%) in a combination of specialist counselling combined with pharmaceutic support (80.90%). Conclusion: The development of Swiss national guidelines for smoking cessation and the implementation of cessation counselling in standardized lung cancer care pathways is warranted in Switzerland to improve long-term survival and perioperative outcome of lung cancer patients.

Association of hemoglobin, albumin, lymphocyte, and platelet score with risk of all-cause and cause-specific mortality among cancer survivors: NHANES 1999-2018.

Background: The HALP score, comprising hemoglobin, albumin, lymphocyte, and platelet levels, serves as an indicator of both nutritional and inflammatory status. However, its correlation with all-cause and cause-specific mortality among cancer survivors remains unclear. Therefore, this study aims to investigate the relationship between HALP scores and mortality outcomes in this population. Method: We extracted cohort data spanning ten cycles (1999-2018) from the U.S. National Health and Nutrition Examination Survey (NHANES). Mortality rates, determined using the National Death Index (NDI) as of December 31, 2019, were assessed. Weighted multivariate logistic regression analyzed the association between HALP scores and cancer prevalence. Kaplan-Meier analyses and weighted multivariate-adjusted Cox analyses investigated the link between HALP scores and all-cause and cause-specific mortality in cancer survivors. Restricted cubic spline (RCS) analysis was employed to assess nonlinear relationships. Furthermore, multi-parametric subgroup analyses were conducted to ensure the robustness of the results. Results: Our study included 41,231 participants, of whom 3,786 were cancer survivors (prevalence: 9.5%). Over a median follow-up of 91 months (range: 51-136), we observed 1,339 deaths, including 397 from cancer, 368 from cardio-cerebrovascular disease, and 105 from respiratory disease. Elevated HALP scores showed a consistent association with reduced cancer incidence (P for trend <0.001). In multivariable-adjusted Cox regression analyses, HALP scores were significantly inversely associated with all-cause mortality, cancer mortality, cardio-cerebrovascular disease mortality, and respiratory disease mortality in cancer survivors (P for trend < 0.05). Nonlinear relationships between HALP scores and all-cause and cause-specific mortality in cancer survivors were evident through RCS regression modeling (P for nonlinearity < 0.01). Kaplan-Meier analyses demonstrated that higher HALP scores were indicative of a poorer prognosis. Conclusion: Our findings indicate a notable inverse correlation between HALP scores and both all-cause and cause-specific mortality among cancer survivors.

Association between systemic immune-inflammation index and cataract among outpatient US adults.

Background: While several studies have noted a higher SII correlates with multiple diseases, research on the association between SII and cataract remains limited. Our cross-sectional study seeks to examine the association between SII and cataract among outpatient US adults. Methods: This compensatory cross-sectional study utilized NHANES data from 1999 to 2008 cycles, conducting sample-weighted multivariate logistic regression and stratified analysis of subgroups. Results: Among 11,205 adults included in this study (5,571 [46.2%] male; 5,634 [53.8%] female), 2,131 (15.2%) had cataract and 9,074 (84.8%) did not have cataract. A fully adjusted model showed that SII higher than 500 × 109/L was positively correlated with an increased risk of cataracts among women (OR, 1.27; 95% CI, 1.02-1.59) (p = 0.036). However, no difference was found in the men subgroup, and there was no significant interaction between SII and sex. Conclusion: Our results indicated that a SII higher than 500 × 109/L was positively correlated with an increased risk of cataracts in women. This study is the first to specifically investigate the impact of a high SII on cataract risk in outpatient adults in the United States. By effectively addressing inflammation, it is possible to mitigate cataract progression and significantly enhance patient outcomes.

Prevalence, Determinants, and Coping Strategies of Preoperative Anxiety Among Surgical Patients: A Cross-Sectional Study in Jazan, Saudi Arabia.

BACKGROUND: Preoperative anxiety is a prevalent concern among surgical patients, significantly impacting their well-being and recovery. Common sources of anxiety include fears related to pain, anesthesia, and surgical outcomes. Despite the importance of addressing this issue, there is limited research on preoperative anxiety in Jazan, Saudi Arabia. This study explores the prevalence, determinants, and coping strategies for preoperative anxiety among surgical patients in this region. METHODS: A cross-sectional study was conducted using an online survey distributed to patients scheduled for surgery at healthcare facilities in Jazan. The survey collected data on demographics, surgical history, anxiety symptoms, sources of anxiety, and coping strategies. Descriptive statistics were used to analyze the data. RESULTS: The study included 312 participants, primarily young adults aged 18-24 years. The majority reported experiencing anxiety symptoms such as nausea (47.8%), sweating (47.8%), and irritability (41.3%). Pain (54.2%), surgical outcomes (49.0%), and anesthesia (32.4%) were the most common sources of anxiety. Support from family and friends (66.7%) and relaxation techniques (26.6%) were identified as the most effective coping strategies. A significant proportion (71.8%) expressed a need for additional support. CONCLUSION: Preoperative anxiety is common among surgical patients in Jazan, driven mainly by concerns about pain, anesthesia, and surgical outcomes. Effective coping strategies include support from family and friends and relaxation techniques. There is a need for additional support resources to improve patient care and reduce anxiety.

Patterns and Motivations of Topical Steroid Use for Skin Whitening in Jazan, Saudi Arabia: A Cross-Sectional Survey.

Background The use of topical steroids for skin whitening is prevalent in many regions, including Saudi Arabia. This study aims to analyze the patterns, motivations, and demographic factors associated with the use of topical steroids for cosmetic purposes in Jazan, Saudi Arabia. Methods This cross-sectional survey was conducted online over three weeks. A structured questionnaire was distributed to adults residing in Jazan, collecting data on demographics, topical steroid use, motivations, and product sources. Descriptive statistics were used to analyze the data. Results Among the 340 participants, 173 (50.9%) reported using topical steroids for skin whitening. The majority of users were female (149, 43.8%) and aged between 20 and 30 years (78, 22.9%). Most participants had used topical steroids for less than a year (127, 73.4%), with usage predominantly in the evening (86, 49.7%). Topical steroids were primarily purchased from pharmacies (70, 40.5%), with significant monthly expenditure variability: 55 participants (31.8%) spent between 50 and 110 SAR, and 62 (35.7%) spent more than 150 SAR. Motivations for use included a preference for lighter skin (49, 28.4%) and treatment of melasma (42, 24.3%). Recommendations from friends (71, 41.0%) and TV advertisements (34, 19.8%) influenced product choice. Conclusion Topical steroid use for skin whitening is widespread among adults in Jazan, with a notable emphasis on cosmetic outcomes and substantial financial investment. There is a critical need for increased public education on the risks associated with topical steroids and enhanced professional guidance to promote safer usage practices.

Reconsidering Public Attitudes Toward Deceased Organ Donation Registration.

Background: The aim of the current study is to understand Americans' attitudes toward deceased organ donation and to assess their level of acceptance on positions toward organ donation. Methods: In summer and winter of 2023, 2 national samples completed measures of attitudes toward donation, reported their registration status, rated positions related to donation, and provided demographic information. Results: Data from 2 samples indicated registration estimates between 50% and 57% and a significant proportion of those unregistered reported reluctance to register. The believability of national registry estimates and ratings of acceptability of 9 organ donation positions differed by registration status. Conclusion: Mass media and motor vehicles interventions seeking to increase registration rates should take into consideration individual attitudes and support toward donation may not be as strong as once thought.

Dysphagia Screening in Residential Long-Term Care Settings in the Republic of Ireland: A Cross-Sectional Survey.

Dysphagia affects up to 70% of older adults living in residential long-term care settings (RLTCS) and may lead to serious complications if not identified and adequately managed. However, there is a dearth of clinical guidelines tailored to older adults at risk of dysphagia in RLTCS. An online survey consisting of 40 questions was conducted to identify dysphagia screening practices, referral patterns and interventions implemented by nurses in cases of suspected dysphagia, to quantify the number of residents with dysphagia, episodes of aspiration pneumonia in the previous year, and use of modified texture diets and fluids and explore differences between groups of RLTCS. The survey was developed using Qualtrics XM Platform and circulated via email, with one response per RLTCS sought. Data were analysed using RStudio. Of the 429 RLTCS contacted, 45 completed and returned the survey, a 10.5% response rate. Dysphagia screening practices, referral patterns, and dysphagia management interventions varied across participating RLTCS. All participants reported that they observe for signs and symptoms of dysphagia at mealtimes to identify residents at-risk of dysphagia. Ninety six percent of RLTCS reported referring residents with suspected dysphagia to speech and language therapy dysphagia services. A diagnosis of dysphagia was reported in 35.3% of residents. All participating RLTCS reported providing modified texture diets and fluids if residents had suspected dysphagia. The implementation of standardised and validated dysphagia screening protocols in RLTCS in the Republic of Ireland may be useful in supporting the identification of at-risk residents.

Consensus for the Development of a New Early Warning Score for Predicting Patients' Clinical Deterioration in Angola: A Delphi Study.

Background: Nearly 30 years since its inception, the early warning scores (EWSs) remain pivotal, yet variations have emerged for hospital and prehospital use. Aggregated scores, reflecting multiple physiological parameters, outperform single-parameter systems in assessing acute illness severity, though consensus on optimal approaches is lacking. Resource-limited countries, including Angola, lack adapted EWSs, emphasizing the need for cost-effective and adaptable solutions to enhance patient care. Objective: To explore the perspectives of Angolan experts to identify physiological parameters suitable for incorporation into existing EWSs, allowing the development of a new tool adjusted to the healthcare context in Angola. Methods: We conducted a three-round Delphi survey, engaging a national expert panel comprising twenty-five physicians and nurses with expertise in internal medicine, surgery, emergency rooms, intensive care units, and/or teachers at universities or at teaching courses in these fields. Participants were asked to rate items using a five-point Likert scale. Consensus was achieved if the items received a rating ≥ 80% from the panel. Results: Consensus was evident for the inclusion of standard physiological parameters, such as systolic blood pressure, heart rate, respiratory rate, temperature, oxygen saturation, neurological status, and the presence or absence of supplemental oxygen. Furthermore, there was consensus for the consideration of specific items, namely, seizures, jaundice, cyanosis, capillary refill time, and pain-typically not included in the current EWSs. Consensus was reached regarding the exclusion of both oxygen saturation and temperature measurements in healthcare settings where oximeters and thermometers might not be readily available. Conclusion: Angolan experts were able to identify the physiological parameters suitable for incorporation into the basic EWSs. Further study must be conducted to test and validate the impact of the newly suggested vital parameters on the discriminant and predictive capability of a new aggregated model specifically adjusted to the Angolan healthcare setting.

Effect of community attitudes on suicide mortality in South Korea: a nationwide ecological study.

Background: Attitudes toward suicide are essential in suicide prevention, as suicide is socio-culturally nuanced. Although the relationship between individual attitudes and suicidal behavior has been extensively studied, the effect of community attitudes-aggregated by region-on suicide mortality remains ambiguous. This study explored the association between community attitudes and real-world suicide mortality. Methods: Data on attitudes toward suicide from the 2018 Korea National Suicide Survey (N = 1500) and individual mortality data from the MicroData Integrated System were obtained. Confirmatory factor analysis supported a factor structure with three factors: "Permissiveness," "Unjustified behavior," and "Readiness to help/Preventability." Thirty regional units in South Korea aggregated the data for ecological analysis. We used negative binomial models to examine the association at the regional level, and stratified analysis by gender and age group was conducted. Results: "Permissiveness" was associated with reduced suicide rates in a univariate model (P < 0.001). Adjusting for gender, age, and additional sociodemographics did not alter the association. Additionally, this relationship was observed in males and individuals under 60 years of age after stratification. However, "Unjustified Behavior" and "Readiness to help/Preventability" exhibited no significant association with suicide in any model or stratum. Conclusion: The observed inverse association between permissive community attitudes and suicide contradicts the findings of previous research that links permissive individual attitudes to increased suicidal behavior. Our findings suggest that attitudes may operate differently at the individual and group levels. Although the cross-sectional design and single-country focus of this study warrant further investigation, our findings indicate that attitudes are significant contextual factors in the process of suicide, which could lead to novel approaches in suicide prevention.