Referral Patterns for Youths Identified at Risk for Suicide by Trained Gatekeepers

Background: In order to better understand the posttraining suicide prevention behavior of gatekeeper trainees, the present article examines the referral and service receipt patterns among gatekeeper-identified youths. Methods: Data for this study were drawn from 26 Garrett Lee Smith grantees funded between October 2005 and October 2009 who submitted data about the number, characteristics, and service access of identified youths. Results: The demographic characteristics of identified youths are not related to referral type or receipt. Furthermore, referral setting does not seem to be predictive of the type of referral. Demographic as well as other (nonrisk) characteristics of the youths are not key variables in determining identification or service receipt. Limitations: These data are not necessarily representative of all youths identified by gatekeepers represented in the dataset. The prevalence of risk among all members of the communities from which these data are drawn is unknown. Furthermore, these data likely disproportionately represent gatekeepers associated with systems that effectively track gatekeepers and youths. Conclusions: Gatekeepers appear to be identifying youth across settings, and those youths are being referred for services without regard for race and gender or the settings in which they are identified. Furthermore, youths that may be at highest risk may be more likely to receive those services. </jats:p

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population. The aim of this study was to inform vaccination prioritization by modelling the impact of vaccination on elective inpatient surgery. The study found that patients aged at least 70 years needing elective surgery should be prioritized alongside other high-risk groups during early vaccination programmes. Once vaccines are rolled out to younger populations, prioritizing surgical patients is advantageous