National Survey Research Articles

Findings from the 2019 nationally representative oral health survey for adults in Singapore.

The aim of this study was to present key findings from the 2019 national adult oral health survey in Singapore (NAOHS). A multi-stage stratified sampling method was used to recruit participants for a representative national adult oral health survey. A total of 12 212 households were randomly selected from the National Database on Dwellings in Singapore. Within each household eligible persons aged ≥65 years were automatically invited to participate while a Kish selection method was used to invite those between 21 and 64 years old. The survey comprised a face-to-face interview questionnaire and a clinical examination which recorded details of tooth loss, DMFT, DMFS and prevalence of periodontal disease according to the CPITN and the US CDC-AAP classifications. Weighted analysis was performed to adjust for oversampling, non-response and post-stratification. Multivariate regression with backward stepwise selection was carried out to identify predictors of chronic periodontal disease and untreated dental caries. Six hundred and sixty-three participants completed both the questionnaires and the clinical examination. The prevalence of edentulousness was 2.7%. Of participants, 34.8% presented with untreated dental caries with a higher proportion found in those who were aged ≥60 years, of Malay ethnicity, living in 1-2-room public housing and who only visited the dentist when there was a problem. Mean DMFS and DMFT indices were 24.7 and 7.9 respectively. Based on the CDC-AAP classification, the prevalence of moderate-severe chronic periodontitis was 56.9% and increased with age, with a higher proportion in males. Participants with untreated dental caries were more likely to have moderate or severe periodontal disease. Survey findings showed high prevalence of dental caries and periodontal disease, at 34.8% and 77.6% respectively. A clear socio-economic gradient in the distribution of tooth loss, untreated dental caries and moderate-to-severe periodontitis was observed.

Polarization, the Pandemic, and Public Trust in Health System Actors.

Public opinion on the performance of health system actors is polarized today, but it remains unclear which actors enjoy the most (least) trust among Democrats and Republicans, whether the Covid-19 pandemic has influenced how people view their own physicians, and whether doctors have retained the ability to influence public beliefs about policy issues. We conducted two national surveys in 2022 and 2023 to examine these questions. Democrats rate the performance of medical research scientists and public health experts during the pandemic more highly than do Republicans and independents. About three in ten Republicans say that the pandemic decreased their trust in their personal doctors. Nonetheless, most Americans report confidence in physicians. We replicate the findings of Gerber et al. (2014) to demonstrate that respondents continue to have more positive views of doctors than other professionals, and that public opinion is responsive to cues from a doctors' group. What polarizes Democrats and Republicans today is not whether medical scientists and public health experts are competent, but whether the advice offered by these actors is in the public interest and should guide policymakers' decisions. Democrats strongly believe the answer to these questions is yes, while Republicans exhibit skepticism.

Comparing harm reduction and overdose response services between community-based and public health department syringe service programmes using a national cross-sectional survey

Syringe services programmes (SSPs) are an evidence-based strategy to reduce infectious diseases and deliver overdose prevention interventions for people who use drugs. They face regulatory, administrative, and funding barriers that limit their implementation in the US, though the federal government recently began providing funding to support these efforts. In this study we aim to understand whether the organisational characteristics of SSPs are associated with the provision of syringe and other overdose response strategies. We examine four outcomes using the National Survey of Syringe Services Programs (NSSSP) (N=472): syringe distribution, naloxone distribution, fentanyl test strip (FTS) availability, and buprenorphine implementation. These outcomes are assessed across three organizational categories of SSPs-those operated by public health departments (DPH), community-based organizations (CBOs) with government funding, and CBOs without government funding-while adjusting for community-level confounders. The proportion of SSPs by organizational category was 36% DPH, 42% CBOs with government funding, and 22% CBOs without government funding. Adjusting for community-level differences, we found that CBO SSPs with government funding had significantly higher provision of all four syringe and overdose response services as compared to DPH SSPs and across three of the four services as compared to CBO SSPs without government funding. CBO SSPs without government funding still had significantly higher provision of three of the four services as compared to programmes maintained by the DPH. CBO SSPs have strong potential to expand overdose response services nationally, particularly if provided with sustained and adequate funding. Communities should aim to provide funding that does not hinder SSP innovation so they can remain flexible in responding to local needs. This study was supported by Arnold Ventures (20-05172).

Associations of cannabis use, use frequency, and cannabis use disorder with violent behavior among young adults in the United States

BackgroundMost violent crimes (52 %) are committed by adults aged 18–34, who account for 23 % of the US population and have the highest prevalence of cannabis use and cannabis use disorder (CUD). We examined whether and how associations of cannabis use, use frequency, and CUD with violent behavior (i.e., attacking someone with the intent to harm seriously) vary by sex in U.S. young adults. MethodsData were from 113,454 participants aged 18–34 in the 2015–2019 US National Surveys on Drug Use and Health, providing nationally representative data on cannabis use, CUD (using DSM-IV criteria), and violent behavior. Descriptive analyses and bivariate and multivariable logistic regression analyses were conducted. ResultsAmong U.S. adults aged 18–34, 28.9 % (95 % CI = 28.5–29.2 %) reported past-year cannabis use (with/without CUD), including 20.5 % (95 % CI = 20.2–20.8 %) with non-daily cannabis without CUD, 4.7 % (95 % CI = 4.5–4.8 %) with daily cannabis use without CUD, 2.1 % (95 % CI = 1.9–2.2 %) with non-daily cannabis use and CUD, and 1.7 % (95 % CI = 1.5–1.8 %) with daily cannabis use and CUD. Past-year adjusted prevalence of violent behavior was higher among males with daily cannabis use but without CUD (2.9 %, 95 % CI = 2.4–2.7 %; adjusted prevalence ratio (PR) = 1.7, 95 % CI = 1.3–2.2) and males with daily cannabis use and CUD (3.1 %, 95 % CI = 2.3–4.0 %; adjusted PR = 1.8, 95 % CI = 1.3–2.4) than males without past-year cannabis use (1.7 %, 95 % CI = 1.6–1.9 %). Adjusted prevalence of violent behavior was higher among females with cannabis use regardless of daily cannabis use/CUD status (adjusted prevalence = 1.6–2.4 %, 95 % CIs = 0.9–3.2 %; adjusted PRs = 1.6–2.4, 95 % CI = 1.3–3.2) than females without past-year cannabis use (1.0 %, 95 % CI = 0.9–1.1 %). ConclusionsResearch is needed to ascertain the directionality of the associations between cannabis use and violent behavior and underlying sex-specific mechanism(s). Our results point to complex sex-specific relationships between cannabis use frequency, CUD, and violent behavior and highlight the importance of early screening for and treatment of CUD and of preventive interventions addressing cannabis misuse.

The impact of dietary acid load on super-agers with exceptional cognitive abilities: a propensity score analysis of national health and nutrition examination survey (NHANES) 2011–2014

Objectives'Super-agers,' individuals over 80 with memory abilities comparable to those 20–30 years younger. The relationship between super-agers and dietary acid load (DAL) is an area that warrants further investigation. We aim to examine the link between DAL and super-agers and assess DAL's effects on cognitive functions across different age groups and cognitive domains. DesignEmploying a cross-sectional analysis of the 2011–2014 National Health and Nutrition Examination Survey (NHANES) data, we utilized propensity score analysis and multivariate-adjusted regression to mitigate confounding factors. SettingOlder adults aged 60 and above in the United States. ParticipantsOur primary analysis encompassed 985 older adults, supplemented by a sensitivity analysis with 2,522 participants. MeasurementsDAL was assessed through potential renal acid load (PRAL), estimated net acid excretion (NAEes), and net endogenous acid production (NEAP) indices. ResultsSuper-agers demonstrate a preference for alkaline diets, shown by their lower DAL indices. After inverse probability of treatment weighting (IPTW), multivariate-adjusted logistic regression reveals that each unit reduction in NAEes and PRAL increases the chances of being a super-ager by 3.9% and 3.0%, respectively. The DAL's impact on cognitive function becomes more pronounced with age. Lower PRAL and NAEes scores are significantly linked to higher situational memory and overall cognitive performance scores in those over 70, with these effects being even more pronounced in participants over 80. ConclusionThis research pioneers in demonstrating that super-agers prefer an alkaline diet, highlighting the potential role of alkaline diet in countering cognitive decline associated with aging.

Perceptions of Responsibilities by Primary Care Staff in a Patient-Centered Medical Home.

To examine the extent to which Veterans Health Administration (VHA) Patient-Aligned Care Team (PACT) members have a shared understanding/ agreement upon and enact responsibilities within the team. The PACT model focuses on team-based care management. However, lack of a shared understanding of team-based care management roles and responsibilities makes system-wide implementation a challenge. Quantitative and qualitative analysis of national survey data collected in 2022 from primary care personnel working in a VHA-affiliated primary care facility. Significant discrepancies exist in responses about what core team members say they do and what others perceive they should be doing, indicating either a lack of agreement, knowledge, or training about what core team members should do. Successful implementation of a team-based model requires adequate support and training for teamwork including shared mental models to work according to their clinical competency. Clear guidance and communication of expectations are critical for role clarity.

Brazilian Dialysis Survey 2022.

The Brazilian Dialysis Survey (BDS) is an annual national survey about patients on chronic dialysis that contributes to health policies. To report the 2022 epidemiological data from the BDS of the Brazilian Society of Nephrology (BSN). A survey was carried out in Brazilian chronic dialysis centers using an online questionnaire that included clinical and epidemiological aspects of patients on chronic dialysis, dialysis therapy data, and dialysis center characteristics. Overall, 28% (n = 243) of the centers answered the questionnaire. In July 2022, the estimated total number of patients on dialysis was 153,831. The estimated prevalence and incidence rates of patients per million population (pmp) were 758 and 214, respectively. Of the prevalent patients, 95.3% were on hemodialysis (HD, 4.6% of these on hemodiafiltration) and 4.7% on peritoneal dialysis (PD). Only 1.3% of patients were not vaccinated against COVID-19. The prevalence of anemia (Hb < 10g/dL) was 27% and hyperphosphatemia (P > 5.5mg/dL) reached 30%. The estimated overall crude annual mortality rate was 17.1%. The absolute number and prevalence rate of patients on chronic dialysis continue to increase. A growing number of patients were receiving hemodiafiltration. The mortality rate decreased, probably due to the end of COVID-19 pandemic. The conclusions were drawn in the context of relatively low voluntary participation, which imposed methodological limitations on our estimates.

National survey for pediatricians in Argentina: Vaccination in daily practice, perception of knowledge and barriers.

Introduction. The decline in vaccination coverage has been very significant in the past decade. Pediatricians play a key role in catching-up coverage and increasing confidence in vaccination. Objectives. To describe pediatricians' perceptions of vaccine knowledge and practices and to identify barriers to access. Methods. Observational, analytical study using an online survey. Variables related to professional profile, training and barriers to vaccination were included. Results. A total of 1696 pediatricians participated (response rate: 10.7%). Their mean age was 50.4 years; 78.7% were women; 78.2% had ≥ 10 years of experience; 78.4% provided outpatient care and 56.0%, in the private subsector; and 72.5% received training in the past 2 years. Respondents described themselves as "trained" in convey the following aspects to their patients: benefits of vaccines: 97.2%; campaign objectives: 87.7%; contraindications: 82.4%; adverse effects: 78.9%; catch- up vaccination: 71.2%; reporting of events supposedly attributable to vaccination or immunization: 59.5%. The proportion was statistically higher in all aspects, among pediatricians with ≥ 10 years of experience and those who received training recently (p ≤ 0.01). The barriers identified in access to vaccination were false contraindications (62.3%), temporary vaccine shortage (46.4%), cultural reasons (41.4%), and restricted vaccination center hours (40.6%). Conclusions. The perception of the level of training varied depending on the vaccination-related aspect. Pediatricians with more years of professional experience and those who received recent updates perceived themselves as more trained. Multiple barriers associated with access to vaccination were identified.

Adverse Childhood Experiences and Health Outcomes Among Transition-Age Autistic Youth.

Adverse childhood experiences (ACEs) have been associated with poor health outcomes in the general population. However, their impact on autistic youth remains unclear. The primary objective was to understand how childhood adversity is related to the general health, mental health, and physical health of transition-age autistic youth. Using data from the 2018-2021 National Survey of Children's Health, this cross-sectional study involved 2056 autistic youth aged 12-17. Logistic regression was employed to test the association between three measures of ACEs - individual ACEs, cumulative ACEs, and grouped ACEs based on contexts, and health outcomes of autistic youth. Our study observed a high prevalence of ACEs among autistic youth, with a substantially higher proportion experiencing multiple ACEs than their neurotypical peers. Individual ACEs were significantly associated with specific health issues. Cumulative ACEs demonstrated a clear dose-response relationship with health outcomes, with higher ACE counts increasing the likelihood of experiencing poor general health, mental health conditions, and physical health issues. Moreover, grouped ACEs associated with health differently, with community-based ACEs being particularly linked to general health status, mental health conditions, and physical health conditions, while family-based ACEs correlated more with more severe mental health conditions and being overweight. These findings collectively emphasize the importance of addressing ACEs as a public health concern among transition-age autistic youth, highlighting the need for targeted interventions, prevention strategies, and support services to mitigate the negative impact of ACEs on the overall well-being of this growing community.

Psychiatry Resident Physicians Experience Personal and Professional Grief, Burnout and Depression: Results From a National Survey.

Resident physicians experience personal and professional stressors throughout training. These experiences may increase levels of burnout, depression, and grief. Understanding how these stressors impact trainees is essential for improving wellbeing during residency. We examined the prevalence and associations between burnout, depression, and grief among a national sample of psychiatry resident physicians. A survey including validated scales for burnout (Modified Maslach Burnout Inventory-Health Services Survey [MBI]), depression (Patient Health Questionnaire-9 [PHQ-9]), and grief (Traumatic Grief Inventory Self Report [TGSIR]) was distributed to 296 psychiatry program directors in January 2023 for dispersal to their respective residents. Fifty-seven participants completed the survey out of 245 participants who opened and started the survey (23.3%). All participants were current psychiatry residents. MBI scores averaged 21.2 (SD 6.5, range 11-40); 11 participants reported high levels of burnout (scores >27; 19.3%). PHQ-9 scores averaged 3.42 (SD 3.0, range 0-14), with 8 responses meeting the criteria for moderate depressive symptoms (scores >10-14; 14.0%). Suicidal ideation was reported by 5 of 57 participants (8.7%). TGISR scores averaged 12.2 (SD 11, range 0-43); no participants met the criteria for pathologic grief. TGISR scores were correlated with MBI (r = .30; P = .02) and PHQ-9 scores (r = .53; P < .0001). MBI scores were also correlated with PHQ-9 scores (r = .54; P < .0001). Non-pathological grief was correlated with burnout and depression. 14% to 20% of psychiatry residents reported clinically significant levels of burnout and depression. Future studies should aim to further characterize burnout, depression, and grief in larger samples of trainees.

Changes of sex ratio at birth and son preferences in China: a mixed method study

AbstractIn 2020, China’s sex ratio at birth (SRB) stood at 111.3, still exhibiting a notable bias. Son preference ranks as the most essential and fundamental reason for the skewed SRB. This study, using a mixed-methods approach, seeks to address what the temporal changes and regional differences in SRB and the gender preferences are in China, whether and why son preference persists, how people practice such preferences and how they relate to the persistently high SRB in the Chinese context. Analysis of data from five national sample surveys finds that son preference is waning and daughter preference is gaining momentum, consistent with significant downward trends in SRB. The study also reveals that value shifts and intergenerational relations have a strong influence on gender preferences and their translation into reproductive behavior. Additionally, this study highlights the challenges that are hindering the decline in son preference, suggesting that more efforts are needed to empower women and to change social norms.

Adventures with Anxiety: Gender bias in using a digital game for teaching vocational English

AbstractBackgroundIn Norway, games were introduced into the 2020 English curriculum; acknowledging games as language learning resources alongside other text‐based material. However, little is known about the type of games selected by English teachers, reasons for doing so, or how games are actually used in teaching. This is particularly relevant in gendered vocational classes, with mainly girls or boys respectively in different programmes, as national surveys show that while most teenage boys play digital games, comparatively few girls do.ObjectivesThe primary aim was to investigate how the digital commercial game Adventures with Anxiety was used during naturally occurring English teaching in four gendered vocational classes: one Technological and Industrial Production class (boys only) and three Healthcare, Childhood and Youth development classes (girls mainly).MethodsParticipants involved 36 students (aged 16–17) and two English teachers. Using a mixed methods design (Brevik, 2022), we combined quantitative and qualitative analyses of classroom video recordings (5.5 h), student screen recordings during gameplay (8 h) and retrospective teacher interviews (1.5 h). Analyses relied on the validated PLATO observation protocol (Grossman, 2015) and reflexive thematic analysis (Braun &amp; Clarke, 2022).Results and ConclusionsEnglish teachers expressed a dual aim in using the game for teaching English; to improve students' language skills and provide experiences of how to live with anxiety. Although the game offered relevant vocabulary and virtual experiences with anxiety; anxiety emerged as a professional component of caring professions in the girls‐mainly classes, while being used to help boys acknowledge anxiety in their own lives.

Predictive value of Cmmi-MHR combined with thromboelastography parameters in acute cerebral infarction.

Cerebral infarction is a common neurological disease with high rates of morbidity, mortality, and recurrence, posing a great threat to human life and health. Cerebral infarction is the second leading cause of death in the world and the leading cause of long-term disability in humans. The results of the third national retrospective sampling survey on causes of death in 2008 showed that cerebral infarction has become the leading cause of death in China and its mortality rate is 4-5 times that of European and American countries. Therefore, this article proposed a study on the predictive value of Cmmi-MHR combined with thromboelastography parameters that was performed for acute cerebral infarction. This paper mainly proposed a high frame rate imaging technology and analyzed its algorithm. In this article, in the experimental part, an in-depth analysis of the predictive value of the Monocyte-to-high-density lipoprotein cholesterol ratio (MHR) combined with thromboelastography parameters was performed for acute cerebral infarction. The final experimental results showed that HDL (OR = 1.695%, P-trend = 0.049) had a probability of death within 90days of hospitalization (OR = 0.81, 95% CI = 1.06-3.11, P-trend = 0.523). There were no significant differences in mortality rate after 90days. Regardless of adjusting for confounders such as age, gender, and NIHSS score, there was no significant difference in the risk of MHR or monocyte count within 90days of hospitalization. The conclusion indicates that the combination of Cmmi-MHR and thromboelastography parameters provides a new perspective and method for the diagnosis and treatment of cerebral infarction, and provides important support for personalized treatment and management of cerebral infarction.

Dental caries prevalence in children during temporary protective care according to type of abuse

BackgroundThis study investigated the correlation between the prevalence of dental caries and the presence and type of abuse.MethodsParticipants were 534 children admitted for care at two child guidance centers (CGCs) in Niigata, Japan. Data pertaining to abuse, including the reason for temporary protective care and the type of abuse, and the oral examination results of the children, were collected. These results were then compared with those of a national survey and analyzed in relation to the presence and type of abuse.ResultsThe odds ratio for decayed teeth was 4.1, indicating a higher risk in children admitted to the CGCs. However, no significant association was found between the presence of decayed, filled, or caries-experienced teeth and the presence of abuse. A significant positive association was observed between dental caries and one type of abuse, indicating a greater prevalence of dental caries in cases of neglect. The findings of this study suggest that the type of abuse, rather than its presence, is associated with dental caries.ConclusionsOur findings suggest that proactive support should be provided to children in problematic nurturing environments, regardless of whether they have been subjected to abuse.

Effects of Racist Microaggressions and Sexual and Gender Minority Stress on Mental Health Among Latinx Lesbian, Gay, Bisexual, Transgender, and Queer or Questioning + Young Adults.

This study examines the effects of racist microaggressions and lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ)-related minority stressors (i.e., identity concealment, family rejection, internalized LGBTQ-phobia, victimization, and racialized heterosexism/cisgenderism) on psychological distress among Latinx LGBTQ+ young people, specifically college students. Participants are a Latinx subset (n = 80) from a national online nonprobability cross-sectional survey of LGBTQ+ college students. The study aim was examined using linear/logistic regression. Findings indicated that racist microaggressions and family rejection were associated with psychological distress. In addition, racist microaggressions were the only stressor associated with clinically significant psychological distress that may warrant psychiatric/psychological treatment. Therefore, racist microaggressions and family rejection are unique stressors that may saliently affect mental health among Latinx LGBTQ+ students. There is a great need to integrate minority stress theory with other critically-oriented theories, such as intersectionality, in research and intervention to eliminate mental health inequities faced by Latinx LGBTQ+ young people.

Does the (socio-political) socialization context matter for paternal involvement?

Previous literature on paternal involvement emphasizes the influence of fathers’ socialization contexts, considering either welfare policies (Hipp and Leuze, 2015) or experiences with their own fathers (Brown et al., 2018; Parke, 1995). In this study, we combine those two branches of research and examine how fathers’ and their fathers’ (grandfathers’) socialization experiences (parental leave regulations in their early adulthood as an example of (de-)familization policies (Lohmann and Zagel, 2016)) predict paternal involvement today. To measure paternal involvement, we create an indicator for involvement that covers Lamb et al. (1985) three aspects of direct interaction, responsibility, and availability and the fact that a father has taken paternal leave for at least one of his children or not. We use the fact that a substantial proportion of the fathers in the German, national survey AID:A 2019 (Kuger et al., 2020) were socialized in another welfare state regime (6.3% of fathers have a direct and another 13.5% have an indirect migration background (their fathers were born in another country) covering birth cohorts from the 1970s to the 1990s; total N = 1053). We then add context-related information on their (fathers’ and grandfathers’) countries of origin from the OECD family database and estimate an SEM model to test potential direct and indirect effects. We find that more educated fathers who experienced extended parental leave regulations are more involved fathers today. Our results support, thus, that welfare state conditions influence individuals’ behaviour while education is a relevant moderator in this relationship.

Catastrophic costs incurred by tuberculosis affected households from Thailand’s first national tuberculosis patient cost survey

Tuberculosis (TB) causes an economic impact on the patients and their households. Although Thailand has expanded the national health benefit package for TB treatment, there was no data on out-of-pocket payments and income losses due to TB from patients and their household perspectives. This national TB patient cost survey was conducted to examine the TB-related economic burden, and assess the proportion of TB patients and their households facing catastrophic total costs because of TB disease. A cross-sectional TB patient cost survey was employed following WHO methods. Structured interviews with a paper-based questionnaire were conducted from October 2019 to July 2021. Both direct and indirect costs incurred from the patient and their household perspective were valued in 2021 and estimated throughout pre- and post-TB diagnosis episodes. We assessed the proportion of TB-affected households facing costs > 20% of household expenditure due to TB. We analyzed 1400 patients including 1382 TB (first-line treatment) and 18 drug-resistant TB patients (DR-TB). The mean total costs per TB episode for all study participants were 903 USD (95% confident interval; CI 771–1034 USD). Of these, total direct non-medical costs were the highest costs (mean, 402 USD, and 95%CI 334–470 USD) incurred per TB-affected household followed by total indirect costs (mean, 393 USD, and 95%CI 315–472 USD) and total direct medical costs (mean, 107 USD, and 95%CI 81–133 USD, respectively. The proportion of TB-affected households facing catastrophic costs was 29.5% (95%CI 25.1–34.0%) for TB (first-line), 61.1% (95%CI 29.6–88.1%) for DR-TB and 29.9% (95%CI 25.6–34.4%) overall. This first national survey highlighted the economic burden on TB-affected households. Travel, food/nutritional supplementation, and indirect costs contribute to a high proportion of catastrophic total costs. These suggest the need to enhance financial and social protection mechanisms to mitigate the financial burden of TB-affected households.

Minorities' Diminished Psychedelic Returns: Income and Educations Impact on Whites, Blacks, Hispanics, and Asians.

Growing evidence suggests that the race and ethnic minority population may experience fewer protective effects of psychedelics on mental health. The minority diminished psychedelic returns theory proposes that racism, manifested in socioeconomic inequality, could partially account for the smaller health gains observed. Therefore, it is important to investigate whether socioeconomic inequality reduces the impact of psychedelics on health outcomes for minority populations. Additionally, despite having higher socioeconomic status, it remains unclear whether psychedelic use among minorities is associated with the same level of health benefits as observed in non-Hispanic whites. This study utilizes data from the National Survey of Drug Use (N = 2008 to 2019), which involved 458,372 participants aged 18 and above. The objective is to examine the impact of various psychedelics (MDMA, psilocybin, DMT, ayahuasca, peyote/mescaline, and LSD), as well as lifetime classic psychedelics use (LCPU), on psychological distress in the past month, taking into account socioeconomic factors (education level and family income) and race/ethnic differences (White, Black, Hispanic, and Asian). The analysis employed a series of nested ordinary least-square regression models using Stata 18. The results indicate that, after controlling for socioeconomic status, there is no association between Black and Hispanic psychedelic use and distress. However, white psychedelic use remains associated with lower levels of distress. Additionally, despite having higher levels of education and income, psychedelic use among minority groups does not appear to be linked to reduced stress. In fact, for Asians with higher education and income, certain psychedelic use is associated with increased distress.

Gaining exposure on perceptions of sunscreen: a national survey of melanoma patients.

Melanoma incidence is increasing. We ascertained perceptions regarding sunscreen and factors influencing choice in patients with melanoma. A survey was distributed to all the supporters of a melanoma patient support group. 571 responses were received across six weeks. Most (79.2%; n=452) indicated they knew how much sunscreen to apply; the most popular frequency of application was once daily (32%, n=180). The most popular cosmetic benefit respondents indicated was reduced redness on sun-exposed areas of skin (73.2%; n=418). Most (96.7%; n=552) agreed more education is needed regarding importance of wearing sunscreen. The three most popular factors in influencing sunscreen choice were SPF more than 50 (n=299; 52.4%), recommendation by a dermatologist (n=267; 46.8%) and price (n=262; 45.9%). Sustainable package design (n=45; 7.9%) and ethical sourcing of ingredients (n=65; 11.4%) were not ranked highly. Given 42% (n=240) only applied sunscreen during sunshine, an education campaign is required. Industry should consider public education regarding sustainability. A further study ascertaining views and perceptions of sunscreen in the non-melanoma cohort is strongly encouraged.

Adherence to General Medical Council guidance regarding disclosure of alternative treatments during the consent process.

General Medical Council (GMC) guidelines dictate that reasonable alternatives to treatment should be disclosed during the consent process. We aimed to determine whether GMC guidelines on disclosure of alternatives during consent are being followed in a real-world example which is disclosure of non-operative management as an alternative to appendicectomy in uncomplicated paediatric appendicitis. We undertook a retrospective single-centre observational study and national consultant specialist paediatric surgeon survey. Two groups of 50 consecutively treated children (<16 years) with acute uncomplicated appendicitis were included in the observational study during two periods. UK-based consultant surgeons who treat appendicitis were included in the national survey. The main outcomes were disclosure and use of non-operative management (NOM) as an alternative to appendicectomy. Overall, in the observational study, NOM was disclosed in 30 (30%) children and 77% (23/30) opted for this treatment method when it was disclosed. There were 83 survey respondents representing all 25 eligible specialist paediatric surgery centres. Ten (12%) consultants reported routinely offering NOM, 39 (47%) offer it in select circumstances, and 34 (41%) never offer NOM. Only 25 (30%) respondents always disclose NOM as an alternative to appendicectomy, whereas 22 (27%) never do. Consultants who never disclose NOM are more likely to prefer appendicectomy over NOM compared with those who always disclose it (p<0.001). In this illustrative clinical scenario, observed and reported practice regarding disclosure of alternative treatments during the consent process do not meet GMC guidance. This risks depriving children and caregivers of a choice that they are entitled to.