A systematic review of rapid needs assessments and their usefulness for disaster decision making:Methods, strengths and weaknesses and value for disaster relief policy

Disaster and humanitarian aid authorities are expected to ensure a timely responsive to the needs of populations affected by disaster. However, they typically have to operate under challenging conditions, hindered by lack of time, capacity and other practical complications. Aim of this systematic review is to provide a comprehensive overview of the methods, strengths and weaknesses and implementation factors of rapid needs assessments (RNAs) in a disaster context. A structured search was applied in PubMed, Web of Science and PsycINFO. A total of 45 assessments were included and categorized in different need categories. Most RNAs focused on health care and basic assistance needs and were mostly carried out in the first days to week post-impact using single measurements, based on questionnaires in (mostly limited) samples of affected populations or occasionally based on registries. Few examples were found that used existing data sources. The review suggests that it is certainly possible to collect information on needs on behalf of disaster decision-making. However, its practical implementation depends on two conditions: the level of preparedness (e.g. availability of standardized pre-developed methods to register the affected for follow-up, standardized measurement instruments and strategies to utilize existing data sources) on the one hand, the nature and dynamic circumstances of the incident on the other. Disaster response authorities are encouraged to give priority to strengthening the first beforehand, while anticipating on the latter, preferably as part of an all hazards approach, with the intention to repeat RNAs beyond the first part of the disaster timeline

Human Health Risks of Conducted Electrical Weapon Exposure:A Systematic Review

Importance: Conducted electrical weapons (CEWs) are used broadly as a less-lethal force option for police officers. However, there is no clear picture of the possible health risks in humans on the basis of rigorously assessed scientific evidence from the international peer-reviewed literature. Objective: To synthesize and systematically evaluate the strength of published evidence for an association between exposure to different models of CEWs and adverse acute as well as chronic conditions. Evidence Review: Following a preregistered review protocol, the literature search strategy was based on a search of reviews published between January 1, 2000, and April 24, 2020, of PubMed, MEDLINE, EMBASE, Web of Science, PsycINFO, and Cochrane Library, as well as relevant online databases and bibliographic sources, such as reference sections of recent publications. The identified studies were independently assessed in terms of scope, relevance, methodologic bias, and quality. Peer-reviewed publications of human studies were included, using original data and with a focus on the use of taser CEWs in the context of law enforcement. Eligible studies examined clearly defined health outcomes as dependent variables following exposure to a CEW. The review followed the relevant sections of the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. A meta-analysis could not be conducted. Findings: Of the 1081 unique records screened, 33 relevant studies were identified, all of them of experimental design and conducted in the US. Eleven studies had a low risk of bias and 22 had a higher bias risk. Studies focused on outcomes such as physiologic stress responses, heart rate, blood pressure, arrhythmias, or cognitive performance. Independently of bias risk, the studies reported few or no acute health problems, apart from the wounds caused by the darts. Furthermore, no long-term outcomes were studied. Most of the studies were performed on healthy, physically fit individuals (eg, police officers) in a controlled setting, with short exposure duration (5 seconds). Half of the studies, mainly those with a higher risk of bias, were at least partly funded by the manufacturer. Conclusions and Relevance: Based on the findings of the reviewed studies, the risk for adverse health outcomes due to CEW exposure can be currently estimated as low. However, most of the reviewed studies had methodologic limitations. Considering that recruited participants were not representative of the population that usually encounters a CEW deployment, it is not possible to draw conclusions regarding exposure outcomes in potentially vulnerable populations or high-risk groups, such as those under the influence of substances

Экзистенциальный базис сущностных сред

Создается экзистенциальная платформа дескриптивных сред. На ее основе строятся модели информатико-технологических систем. Проводится прагматико-обусловленная типизация универсума компаундов. Раскрывается компа- ундная природа средств квантификации и суперпозиции функций.Створюється екзистенційна платформа дескриптивних середовищ. На її основі будуються логіко-математичні моделі інформатико-технологічних систем. Проводиться прагматико обумовлена типізація універсуму компаундів. Розглядається компаундна природа засобів квантифікації та суперпозиції функційAn existential platform of descriptive environments has been created, on the basis of which logic-mathematical models of informative technological systems are built. A pragmatically conditioned typification of the universal set of compounds is performed. The compound nature of the means of quantification and superposition of function is discussed

Immediate and long-term health impact of exposure to gas-mining induced earthquakes and related environmental stressors

BACKGROUND: Little is known about the public health impact of chronic exposure to physical and social stressors in the human environment. Objective of this study was to investigate the immediate and long-term health effects of living in an environment with gas-mining induced earthquakes and related stressors in the Netherlands. METHODS: Data on psychological, somatic and social problems recorded routinely in electronic health records by general practitioners during a 6-year period (2010–2015) were combined with socioeconomic status and seismicity data. To assess immediate health effects of exposure to M(L)≥1.5 earthquakes, relative risk ratios were calculated for patients in the week of an earthquake and the week afterwards, and compared to the week before the earthquake. To analyse long-term health effects, relative risks of different groups, adjusted for age, sex and socioeconomic status, were computed per year and compared. RESULTS: Apart from an increase in suicidality, few immediate health changes were found in an earthquake week or week afterwards. Generally, the prevalence of health problems was higher in the mining province in the first years, but dropped to levels equal to or even below the control group in subsequent years, with lower relative risks observed in more frequently exposed patients. CONCLUSIONS: From a public health perspective, the findings are fascinating. Contrary to our expectation, health problems presented in general practice in the earthquake province decreased during the study period. More frequently exposed populations reported fewer health issues to general practitioners, which might point at health adaptation to chronic exposure to stressors

Risk of pneumonia in the vicinity of goat farms: a comparative assessment of temporal variation based on longitudinal health data

BACKGROUND: Although the association between living in the vicinity of a goat farm and the occurrence of pneumonia is well-documented, it is unclear whether the higher risk of pneumonia in livestock dense areas is season-specific or not. This study explored the temporal variation of the association between exposure to goat farms and the occurrence of pneumonia. METHODS: A large population-based study was conducted in the Netherlands, based on electronic health records from 49 general practices, collected for a period of six consecutive years (2014-2019). Monthly incidence rates of pneumonia in a livestock dense area were compared with those of a control group (areas with low livestock density) both per individual year and cumulatively for the entire six-year period. Using individual estimates of livestock exposure, it was also examined whether incidence of pneumonia differed per month if someone lived within a certain radius from a goat farm, compared to residents who lived further away. RESULTS: Pneumonia was consistently more common in the livestock dense area throughout the year, compared to the control area. Analyses on the association between the individual livestock exposure estimates and monthly pneumonia incidence for the whole six-year period, yielded a generally higher risk for pneumonia among people living within 500 m from a goat farm, compared to those living further away. Significant associations were observed for March (IRR 1.68, 95% CI 1.02-2.78), August (IRR 2.67, 95% CI 1.45-4.90) and September (IRR 2.52, 95% CI 1.47-4.32). CONCLUSIONS: The increased occurrence of pneumonia in the vicinity of goat farms is not season-specific. Instead, pneumonia is more common in livestock dense areas throughout the year, including summer months

Increased risk of pneumonia amongst residents living near goat farms in different livestock-dense regions in the Netherlands

BACKGROUND: Previous studies, performed between 2009-2019, in the Netherlands observed an until now still unexplained increased risk for pneumonia among residents living close to goat farms. Since data were collected in the provinces Noord-Brabant and Limburg (NB-L), an area with relatively high air pollution levels and proximity to large industrial areas in Europe, the question remains whether the results are generalizable to other regions. In this study, a different region, covering the provinces Utrecht, Gelderland, and Overijssel (UGO) with a similar density of goat farms, was included to assess whether the association between goat farm proximity and pneumonia is consistently observed across the Netherlands. METHODS: Data for this study were derived from the Electronic Health Records (EHR) of 21 rural general practices (GPs) in UGO, for 2014-2017. Multi-level analyses were used to compare annual pneumonia prevalence between UGO and data derived from rural reference practices ('control area'). Random-effects meta-analysis (per GP practice) and kernel analyses were performed to study associations of pneumonia with the distance between goat farms and patients' home addresses. RESULTS: GP diagnoses of pneumonia occurred 40% more often in UGO compared to the control area. Meta-analysis showed an association at a distance of less than 500m (~70% more pneumonia compared to >500m) and 1000m (~20% more pneumonia compared to >1000m). The kernel-analysis for three of the four individual years showed an increased risk up to a distance of one or two kilometers (2-36% more pneumonia; 10-50 avoidable cases per 100,000 inhabitants per year). CONCLUSIONS: The positive association between living in the proximity of goat farms and pneumonia in UGO is similar to the previously found association in NB-L. Therefore, we concluded that the observed associations are relevant for regions with goat farms in the entire country

Non-specific physical symptoms in relation to actual and perceived exposure to electromagnetic fields (EMF) : A multidisciplinary approach

The association between non-specific physical symptoms (NSPS) such as headache, fatigue, nausea and sleep problems and exposure to electromagnetic fields (EMF) in the general population has been a subject of ongoing scientific debate and public concern. A limited number of epidemiological studies has used surrogates of actual field strength, while none of those studies has combined self-reported and general practice (GP)-registered data on NSPS. Evidence from experimental studies suggests that symptoms tend to occur when participants believe they are exposed, irrespective of whether their belief is accurate or not. There are no published epidemiological studies that jointly investigated actual and perceived exposure in combination with psychological factors. The thesis comprised two systematic reviews (Chapters 2, 4), a pilot epidemiological study (n=3611) (chapter 3) and the central study carried out in 2011 (Chapters 5, 6), which combined a health survey of adult (≥18) participants (n=5933) with the electronic medical records of the respondents as registered by general practitioners. The systematic review and meta-analysis of epidemiological studies (Chapter 2) showed no evidence for an association between frequency and severity of NSPS and higher levels of actual measured or modelled EMF exposure, while an association with perceived exposure was more distinct. Studies with a higher risk of bias, mainly regarding exposure assessment, sample selection and adjustment for confounders, tended to report more significant symptomatic effects. Chapter 3 demonstrated that increased report of NSPS was associated with self-reported environmental sensitivity, perceived proximity to base stations and high-voltage overhead power lines, lower perceived control and increased avoidance (coping) behavior. No significant association was found between symptom report and actual (geo-coded) distance to base stations or power lines. In Chapter 4, the case definition criteria to identify individuals with IEI-EMF in epidemiological research were summarized: 1) Self-report of being (hyper)sensitive to EMF. 2) Attribution of NSPS to at least one EMF source. 3) Absence of medical or psychiatric/psychological disorder capable of accounting for these symptoms 4) Occurrence of symptoms during or soon after the individual perceives an exposure source or exposed area. Chapter 5 showed that environmentally sensitive individuals experienced poorer health, increased illness behavior (especially related to alternative therapies), more negative symptom perceptions and more severe NSPS, compared to non-(environmentally) sensitive participants. It was also concluded that the number and duration of self-reported NSPS were important components of symptom severity in the investigated groups. Chapter 6 employing various exposure proxies, provided no convincing evidence for an association between everyday life RF-EMF exposure and NSPS and sleep quality in the general population. A few associations were observed between electric appliances and symptoms. Perceived exposure, perceived control and avoidance coping were independently associated with the examined health outcomes. In addition to the cross-sectional design of the study, a number of limitations were also acknowledged, primarily related to the characterization of actual EMF exposure; a highly complex issue that remains a challenge for epidemiological studies internationally

Non-specific physical symptoms in relation to actual and perceived exposure to electromagnetic fields (EMF): A multidisciplinary approach

The association between non-specific physical symptoms (NSPS) such as headache, fatigue, nausea and sleep problems and exposure to electromagnetic fields (EMF) in the general population has been a subject of ongoing scientific debate and public concern. A limited number of epidemiological studies has used surrogates of actual field strength, while none of those studies has combined self-reported and general practice (GP)-registered data on NSPS. Evidence from experimental studies suggests that symptoms tend to occur when participants believe they are exposed, irrespective of whether their belief is accurate or not. There are no published epidemiological studies that jointly investigated actual and perceived exposure in combination with psychological factors. The thesis comprised two systematic reviews (Chapters 2, 4), a pilot epidemiological study (n=3611) (chapter 3) and the central study carried out in 2011 (Chapters 5, 6), which combined a health survey of adult (≥18) participants (n=5933) with the electronic medical records of the respondents as registered by general practitioners. The systematic review and meta-analysis of epidemiological studies (Chapter 2) showed no evidence for an association between frequency and severity of NSPS and higher levels of actual measured or modelled EMF exposure, while an association with perceived exposure was more distinct. Studies with a higher risk of bias, mainly regarding exposure assessment, sample selection and adjustment for confounders, tended to report more significant symptomatic effects. Chapter 3 demonstrated that increased report of NSPS was associated with self-reported environmental sensitivity, perceived proximity to base stations and high-voltage overhead power lines, lower perceived control and increased avoidance (coping) behavior. No significant association was found between symptom report and actual (geo-coded) distance to base stations or power lines. In Chapter 4, the case definition criteria to identify individuals with IEI-EMF in epidemiological research were summarized: 1) Self-report of being (hyper)sensitive to EMF. 2) Attribution of NSPS to at least one EMF source. 3) Absence of medical or psychiatric/psychological disorder capable of accounting for these symptoms 4) Occurrence of symptoms during or soon after the individual perceives an exposure source or exposed area. Chapter 5 showed that environmentally sensitive individuals experienced poorer health, increased illness behavior (especially related to alternative therapies), more negative symptom perceptions and more severe NSPS, compared to non-(environmentally) sensitive participants. It was also concluded that the number and duration of self-reported NSPS were important components of symptom severity in the investigated groups. Chapter 6 employing various exposure proxies, provided no convincing evidence for an association between everyday life RF-EMF exposure and NSPS and sleep quality in the general population. A few associations were observed between electric appliances and symptoms. Perceived exposure, perceived control and avoidance coping were independently associated with the examined health outcomes. In addition to the cross-sectional design of the study, a number of limitations were also acknowledged, primarily related to the characterization of actual EMF exposure; a highly complex issue that remains a challenge for epidemiological studies internationally

Immediate and long-term health impact of exposure to gas-mining induced earthquakes and related environmental stressors

BACKGROUND: Little is known about the public health impact of chronic exposure to physical and social stressors in the human environment. Objective of this study was to investigate the immediate and long-term health effects of living in an environment with gas-mining induced earthquakes and related stressors in the Netherlands. METHODS: Data on psychological, somatic and social problems recorded routinely in electronic health records by general practitioners during a 6-year period (2010-2015) were combined with socioeconomic status and seismicity data. To assess immediate health effects of exposure to ML≥1.5 earthquakes, relative risk ratios were calculated for patients in the week of an earthquake and the week afterwards, and compared to the week before the earthquake. To analyse long-term health effects, relative risks of different groups, adjusted for age, sex and socioeconomic status, were computed per year and compared. RESULTS: Apart from an increase in suicidality, few immediate health changes were found in an earthquake week or week afterwards. Generally, the prevalence of health problems was higher in the mining province in the first years, but dropped to levels equal to or even below the control group in subsequent years, with lower relative risks observed in more frequently exposed patients. CONCLUSIONS: From a public health perspective, the findings are fascinating. Contrary to our expectation, health problems presented in general practice in the earthquake province decreased during the study period. More frequently exposed populations reported fewer health issues to general practitioners, which might point at health adaptation to chronic exposure to stressors