The devastating southeast Asian tsunami of December 26, 2004 has brought home the destructive consequences of coastal hazards in an absence of effective warning systems. Since the 1946 tsunami that destroyed much of Hilo, Hawai'i, a network of pole mounted sirens has been used to provide an early public alert of future tsunamis. However, studies in the 1960s showed that understanding of the meaning of siren soundings was very low and that ambiguity in understanding had contributed to fatalities in the 1960 tsunami that again destroyed much of Hilo. The Hawaiian public has since been exposed to monthly tests of the sirens for more than 25 years and descriptions of the system have been widely published in telephone books for at least 45 years. However, currently there remains some uncertainty in the level of public understanding of the sirens and their implications for behavioral response. Here, we show from recent surveys of Hawai'i residents that awareness of the siren tests and test frequency is high, but these factors do not equate with increased understanding of the meaning of the siren, which remains disturbingly low (13%). Furthermore, the length of time people have lived in Hawai'i is not correlated systematically with understanding of the meaning of the sirens. An additional issue is that warning times for tsunamis gene rated locally in Hawai'i will be of the order of minutes to tens of minutes and limit the immediate utility of the sirens. Natural warning signs of such tsunamis may provide the earliest warning to residents. Analysis of a survey subgroup from Hilo suggests that awareness of natural signs is only moderate, and a majority may expect notification via alerts provided by official sources. We conclude that a major change is needed in tsunami education, even in Hawai'i, to increase public understanding of, and effective response to, both future official alerts and natural warning signs of future tsunamis.

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Suicide, a public health problem on a global scale, has become the focus in many domains across the United States. With the recent push to provide solutions to the adolescent suicide rate in the U.S., the school setting has become an important venue for prevention and intervention efforts. While there are many risk and protective factors, the majority of suicide completions are concurrent with psychiatric disorders among adolescents; as such, this is an area that warrants further investigation. Additionally, school resources are often overwhelmed by the magnitude of need among the student population; therefore, effective interventions must be identified that can feasibly be implemented in the schools. Research has suggested that parent-adolescent relationships are key in the prevention of suicide, yet minimal research has been conducted towards promoting healthy parent-adolescent relationships for at-risk adolescents. Additionally, some research suggests that school and community interventions are only more effective than parental support when negative parent-adolescent relationships are present. This implies that fostering parental support should be a top priority in school-based suicide prevention efforts. This literature review identifies and summarizes pertinent scholarly research and resources for schools to better support parents of adolescents who struggle with suicidal thoughts and previous attempted suicides. As part of an intervention plan which increases home/school collaboration in adolescent suicide prevention, handouts were developed for parents (found in the appendix), which include information on warning signs of suicide, risk factors for suicide, and methods of responding to suicidality. After adapting these handouts to best meet their students' needs, school-based mental health professionals may consider including these handouts in their school's crisis plan and suicide prevention efforts.

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臺灣地區過去三十年來，經濟發展快速，國民生活水準亦大幅提升，在各界戮力為經濟打拼，使我國經濟大幅起飛的同時，我們的社會發展卻在重經濟以及社會變遷影響下，逐漸產生一些可能阻礙社會整體健全發展的不正常現象，導致各種社會問題隨之出現，成為社會進步及創造優質生活的絆腳石，為提供政府及民間相關單位制訂或研擬社會問題防制政策時參考，本研究乃以「文獻法」、「主觀經驗法」及「主成份分析」，編製我國社會警報指標，以一數量化指標綜合評量我國社會問題潛在發展趨勢，並以「顯著水準法」訂定警戒線及對各年超過警戒線者發布警報訊號。 依據社會警報指標各領域社會問題警報分析結果， 87年各項社會問題警報速度超過「輕警」者有「家庭問題」及「犯罪問題」等二領域，尤其是「犯罪問題」更超過巨警，若綜合全體社會問題而言，87年綜合警報速度較前幾年緩和；另就近三年各領域社會問題警報速度觀察，平均較前三年快者有「家庭問題」、「犯罪問題」、「貧富不均問題」及「環境問題」等四領域，惟全體社會問題綜合結果，速度略緩。 / Exertion of the people has promoted the growth of the Taiwan economy for over three decades. However, social dysfunctions, resulted from all the emphases at the economic growth and the changes of the collective values, could have obstructed the development of the society as a whole. In order to served as the references in making social policies related, this study tries to organize "the Taiwan Social Warning Indicators" by statistic methods, such as literature search, subjective experience, and principal component. These quantitative indexes are expected to evaluate the potential tendency of the social issues in Taiwan. On the other hand, the statistical significance method is also applied to establish the warning lines and issue the warning signs when the annual increase rate of the indicator's value－the warning speed－ of the social issues are cross the warning line. In accordance with the analysis results of the social warning indicators in this study, the increase of warning speeds of the Taiwan social issues in 1998 regarding "family" and "crime" exceed the level of "light warning". The warning speed of the "crime issue" even exceeds the level of "extremely serious warning" among all. Furthermore, the warning speed of the comprehensive social issues in the same year is estimated at increasing more lightly than those of those issues in last few years. Another finding on the warning speeds of social issues in different fields is that the result of such a research from 1996 to 1998 is much worse in average on "family issue", "crime issue", "unequal fortune distribution issue", and "environmental issue" than that on the same issue from 1993 to 1995. But the warning speed of the social issues as a whole from 1996 to 1998 increases more slowly than that from 1993 to 1995.

Background The detection of early warning signs is essential in the long-term treatment of bipolar disorders. However, in bipolar patients’ daily life and outpatient treatment the assessment of upcoming state changes faces several difficulties. In this trial, we examine the effectiveness of a smartphone based automated feedback about ambulatory assessed early warning signs in prolonging states of euthymia and therefore preventing hospitalization. This study aims to assess, whether patients experience longer episodes of euthymia, when their treating psychiatrists receive automated feedback about changes in communication and activity. With this additional information an intervention at an earlier stage in the development of mania or depression could be facilitated. We expect that the amount of time will be longer between affective episodes in the intervention group. Methods/design The current study is designed as a randomized, multi-center, observer-blind, active-control, parallel group trial within a nationwide research project on the topic of innovative methods for diagnostics, prevention and interventions of bipolar disorders. One hundred and twenty patients with bipolar disorder will be randomly assigned to (1) the experimental group with included automated feedback or (2) the control group without feedback. During the intervention phase, the psychopathologic state of all participants is assessed every four weeks over 18 months. Kaplan-Meier estimators will be used for estimating the survival functions, a Log-Rank test will be used to formally compare time to a new episode across treatment groups. An intention-to-treat analysis will include data from all randomized patients. Discussion This article describes the design of a clinical trial investigating the effectiveness of a smartphone-based feedback loop. This feedback loop is meant to elicit early interventions at the detection of warning signs for the prevention of affective episodes in bipolar patients. This approach will hopefully improve the chances of a timely intervention helping patients to keep a balanced mood for longer periods of time. In detail, if our hypothesis can be confirmed, clinical practice treating psychiatrists will be enabled to react quickly when changes are automatically detected. Therefore, outpatients would receive an even more individually tailored treatment concerning time and frequency of doctor’s appointments. Trial registration: ClinicalTrials.gov: NCT02782910: Title: “Smartphone-based Ambulatory Assessment of Early Warning Signs (BipoLife_A3)”. Registered May 25 2016. Protocol Amendment Number: 03. Issue Date: 26 March 2018. Author(s): ES.

Adolescent suicide and attempted suicide is an unhealthy practice that involves mental illness which led the suicidal behavior to be an important public health problem globally and in Africa. Suicide prevalence rates in young people in South Africa and in all major ethnic groups are a significant cause for concern. The adolescent mental illness causes sleepless nights on the education system. Though much research has been done on this problem it still remains one of the leading causes of death amongst adolescent learners locally and globally. As a parent and an educator reading news articles, attending memorial services and funerals of adolescent learners who took their own lives, gave me enough reason for actions to be taken in order to find out what is causing adolescents to commit suicide. During this emotional experience as the researcher, I have discovered that the adolescent stage is a very fragile stage. I also discovered that when life stresses strike, coping as an adolescent becomes difficult. This study focuses on an in-depth study of the causative factors of suicide and attempted suicide amongst the adolescent learners of Tshwane North (D3) area. The topic was investigated by means of a literature study and an empirical investigation using a qualitative approach. Data was collected by means of focus group discussion and one to one interview using a tape recorder and taking notes. Participant's answers were analysed individually and compared with all others. Findings shows that adolescent suicide and attempted suicide is a mental disorder that need to be addressed by including physicians and psychologists, upon realizing the warning signs of suicide in order to minimalize the practice. It is also clear that adolescence is a fragile stage of growth and adolescents struggle to cope with life challenges such as peer pressure, parent separations, socialization, pregnancy, chronic illness and academic pressure. It is recommended that NGOs in collaboration with the Health and Education Departments need to take action by organizing workshops to address causative factors of suicide and how to find help when realizing a suicidal adolescent learner. The department of education needs to ensure that adolescent suicide and attempted suicide preventative strategies should be taught from primary school level and be added to life skills subject in all grades. Life Orientation educator's to be trained about adolescent suicide to be well equipped to teach learners on how to recognize warning signs in their peers and friends. / Inclusive Education / M. Ed. (Inclusive Education)

The significance of risk is growing in many Western societies, a phenomenon linked to increasing individualism, personal choice, and outcome uncertainty in multiple spheres of life. Despite being healthier and more physically protected from harm than any previous society, a serious concern for safety and risk control is emerging as a defining characteristic of modern social life. Within the context of a risk-averse society, this thesis investigates the nature and relevance of risk in natural resource recreation and tourism settings. Millions of people every day visit national parks and other protected areas around the world in which natural hazards inhere. Many visitors fail to recognise these hazards, creating moral, legal, and ethical issues for natural resource managers. People travel to national parks anticipating a degree of adventure, to escape routines, and to witness the grandeur of nature. Ironically, the very qualities that attract people to natural areas may also put them at risk. Managers of natural resource tourism and recreation areas in New Zealand are confronted with a paradox born out of visitor demand for nature experiences, a legal obligation to facilitate free access, and a growing social emphasis on health and safety. In particular, this study assesses the risk perceptions of visitors to the Fox and Franz Josef glaciers, popular tourist attractions on the West Coast of New Zealand's South Island, and explores the risk perceptions and beliefs of resource management agency staff. The study also investigates the issue of risk communication at these two sites, and the degree to which existing hazard messages are successful at encouraging appropriate visitor behaviour. Pictorial hazard warning signs are introduced to the sites and their effectiveness evaluated. The findings show that many visitors (especially international visitors) have relatively poor awareness of natural hazards, and behave in ways which potentially compromise physical safety. It is argued that perceptions and behaviour are a consequence of diverse individual and situational factors including limited knowledge of the sites, beliefs about management, poor comprehension of hazard warning signs, and freedom from the normative constraints of everyday life. In contrast to visitors, managers at the glacier sites consider the risks to be significant, and, potentially, severe. It is argued that managers' perceptions of risk are influenced by several important social and site-specific factors, including their own experiences of hazards at the glaciers, perceived legal and moral obligations, the organisational culture, and impressions of high societal expectation concerning safety. The situation is further complicated by the freedom of access principle in national parks, and increasing tourist demand for nature-based experiences. These factors governed beliefs about the subject of risk. This study identifies several dimensions of risk in nature-based recreation and tourism settings. Visitors are at risk of personal accident or injury at certain tourism attractions. Awareness of hazards is limited, visitor behaviour compromises safety, and existing communication strategies are only partially effective. Risk is also apparent in the agency responsible for management of outdoor recreation areas. Site managers perceive a risk in their failure to prevent visitors from harm, whereas senior managers identify risk as primarily financial, legal, and political. Collectively, these factors demonstrate that the phenomenon of risk is increasingly important in the tourism and recreation context, and has the potential to influence significantly both management and experience of protected natural areas in New Zealand.

Adolescent suicide and attempted suicide is an unhealthy practice that involves mental illness which led the suicidal behavior to be an important public health problem globally and in Africa. Suicide prevalence rates in young people in South Africa and in all major ethnic groups are a significant cause for concern. The adolescent mental illness causes sleepless nights on the education system. Though much research has been done on this problem it still remains one of the leading causes of death amongst adolescent learners locally and globally. As a parent and an educator reading news articles, attending memorial services and funerals of adolescent learners who took their own lives, gave me enough reason for actions to be taken in order to find out what is causing adolescents to commit suicide. During this emotional experience as the researcher, I have discovered that the adolescent stage is a very fragile stage. I also discovered that when life stresses strike, coping as an adolescent becomes difficult. This study focuses on an in-depth study of the causative factors of suicide and attempted suicide amongst the adolescent learners of Tshwane North (D3) area. The topic was investigated by means of a literature study and an empirical investigation using a qualitative approach. Data was collected by means of focus group discussion and one to one interview using a tape recorder and taking notes. Participant's answers were analysed individually and compared with all others. Findings shows that adolescent suicide and attempted suicide is a mental disorder that need to be addressed by including physicians and psychologists, upon realizing the warning signs of suicide in order to minimalize the practice. It is also clear that adolescence is a fragile stage of growth and adolescents struggle to cope with life challenges such as peer pressure, parent separations, socialization, pregnancy, chronic illness and academic pressure. It is recommended that NGOs in collaboration with the Health and Education Departments need to take action by organizing workshops to address causative factors of suicide and how to find help when realizing a suicidal adolescent learner. The department of education needs to ensure that adolescent suicide and attempted suicide preventative strategies should be taught from primary school level and be added to life skills subject in all grades. Life Orientation educator's to be trained about adolescent suicide to be well equipped to teach learners on how to recognize warning signs in their peers and friends. / Inclusive Education / M. Ed. (Inclusive Education)