De beelden die ons bewegen:De voorspelbaarheid van de rampen die we samen creëren

Dat rampen en crises een enorme weerslag hebben op de levens van gedupeerden mag voor zich spreken. Dat dit het collectieve organisatievermogen van een samenleving op de proef stelt ligt eveneens voor de hand. Dat de huidige tijd onder spanning staat en dat een diversiteit aan crises en complexe problemen op elkaar inwerkt, is dagelijks onderwerp van gesprek. Het is onvermijdelijk dat dingen mis gaan, maar er lijken hardnekkige patronen in te zitten. Die patronen zijn alleen te doorbreken als we ze beter begrijpen. "De beelden die ons bewegen, de voorspelbaarheid van de rampen die we samen creëren" gaat hier dieper op in en reduceert de crisisopgave op het snijvlak van veiligheid en gezondheid tot zes elementen die in samenhang bepalen of crisisbeheersing voor gedupeerden goed uitpakt. Deze versimpeling verscherpt de opgave voor overheden en instanties– en onderstreept de noodzaak van integraliteit en ontschotting. Het illustreert bovendien waarom de klassieke crisisbeheersingsaanpak, met een focus op acute dreiging, ontoereikend is in een landschap van langdurig sluimerende crises. Waar in de risicosamenleving sterk naar de overheid werd gekeken om problemen aan te pakken, kunnen we er in de huidige crisissamenleving niet op vertrouwen dat de overheid dit alleen kan. Dit is een van de voorspelbare pijnpunten in de tijdslijn van zich ontvouwende rampen waarin we allemaal een aandeel (kunnen) hebben – deels in de problemen, maar hopelijk ook in de oplossing

De beelden die ons bewegen:De voorspelbaarheid van de rampen die we samen creëren

Dat rampen en crises een enorme weerslag hebben op de levens van gedupeerden mag voor zich spreken. Dat dit het collectieve organisatievermogen van een samenleving op de proef stelt ligt eveneens voor de hand. Dat de huidige tijd onder spanning staat en dat een diversiteit aan crises en complexe problemen op elkaar inwerkt, is dagelijks onderwerp van gesprek. Het is onvermijdelijk dat dingen mis gaan, maar er lijken hardnekkige patronen in te zitten. Die patronen zijn alleen te doorbreken als we ze beter begrijpen. "De beelden die ons bewegen, de voorspelbaarheid van de rampen die we samen creëren" gaat hier dieper op in en reduceert de crisisopgave op het snijvlak van veiligheid en gezondheid tot zes elementen die in samenhang bepalen of crisisbeheersing voor gedupeerden goed uitpakt. Deze versimpeling verscherpt de opgave voor overheden en instanties– en onderstreept de noodzaak van integraliteit en ontschotting. Het illustreert bovendien waarom de klassieke crisisbeheersingsaanpak, met een focus op acute dreiging, ontoereikend is in een landschap van langdurig sluimerende crises. Waar in de risicosamenleving sterk naar de overheid werd gekeken om problemen aan te pakken, kunnen we er in de huidige crisissamenleving niet op vertrouwen dat de overheid dit alleen kan. Dit is een van de voorspelbare pijnpunten in de tijdslijn van zich ontvouwende rampen waarin we allemaal een aandeel (kunnen) hebben – deels in de problemen, maar hopelijk ook in de oplossing

Appraising evidence-based mental health and psychosocial support (MHPSS) guidelines:PART I: A systematic review on methodological quality using AGREE-HS

In 2007, the Inter-Agency Standing Committee (IASC) published its guidelines for mental health and psychosocial support (MHPSS) in emergency situations. This was one of the first sets of MHPSS guidelines, developed during the last decades, to aid policymakers and practitioners in the planning and implementation of disaster mental health risk reduction activities. However, the potential merit of MHPSS guidelines for this purpose is poorly understood. The objective of this study is to review available MHPSS guidelines in disaster settings and assess their methodological quality. MHPSS guidelines, frameworks, manuals and toolkits were selected via a systematic literature review as well as a search in the grey literature. A total of 13 MHPSS guidelines were assessed independently by 3–5 raters using the Appraisal of Guidelines for Research and Evaluation–Health Systems (AGREE-HS) instrument. Guideline quality scores varied substantially, ranging between 21.3 and 67.6 (range 0–100, M = 45.4), with four guidelines scoring above midpoint (50). Overall, guidelines scored highest (on a 1–7 scale) on topic (M = 5.3) and recommendations (M = 4.2), while implementability (M = 2.7) is arguably the area where most of the progress is to be made. Ideally, knowledge derived from scientific research aligns with the receptive contexts of policy and practice where risks are identified and mitigated

The impact of influenza and pneumococcal vaccination on antibiotic use:an updated systematic review and meta-analysis

BACKGROUND: Vaccination can prevent bacterial and viral infections that could otherwise increase the chances of receiving (unnecessary) antibiotic treatment(s). As a result, vaccination may provide an important public health intervention to control antimicrobial resistance (AMR).OBJECTIVES: Perform a systematic literature review to better understand the impact of influenza, pneumococcal and COVID-19 vaccination on antibiotic use, and to identify differences in effect between world regions and study designs.METHODS: We performed a systematic literature review and meta-analysis which updated previous literature reviews with new data from 1 October 2018 to 1 December 2021. The study focuses on randomised controlled trials (RCTs) and observational studies. Results from the meta-analysis of RCTs were stratified by WHO region and age group. Vote counting based on the direction of effect was applied to synthesize the results of the observational studies.RESULTS: Most studies are performed in the WHO European Region and the Region of the Americas in high-income countries. RCTs show that the effect of influenza vaccination on the number of antibiotic prescriptions or days of antibiotic use (Ratio of Means (RoM) 0.71, 95% CI 0.62-0.83) is stronger compared to the effect of pneumococcal vaccination (RoM 0.92, 95% CI 0.85-1.00). These studies also confirm a reduction in the proportion of people receiving antibiotics after influenza vaccination (Risk Ratio (RR) 0.63, 95% CI 0.51-0.79). The effect of influenza vaccination in the European and American regions ranged from RoM 0.63 and 0.87 to RR 0.70 and 0.66, respectively. The evidence from observational studies supports these findings but presents a less consistent picture. No COVID-19 studies were identified.CONCLUSION: We find that both RCTs and observational studies show that influenza vaccination significantly reduces antibiotic use, while the effect of pneumococcal vaccination is less pronounced. We were unable to study the effect of COVID-19 vaccination and no clear regional patterns were found due to the high heterogeneity between studies. Overall, our data supports the use of influenza vaccination as an important public health intervention to reduce antibiotic use and possibly control AMR.</p

Exploring the black box of quality improvement collaboratives: modelling relations between conditions, applied changes and outcomes

<p>Abstract</p> <p>Introduction</p> <p>Despite the popularity of quality improvement collaboratives (QICs) in different healthcare settings, relatively little is known about the implementation process. The objective of the current study is to learn more about relations between relevant conditions for successful implementation of QICs, applied changes, perceived successes, and actual outcomes.</p> <p>Methods</p> <p>Twenty-four Dutch hospitals participated in a dissemination programme based on QICs. A questionnaire was sent to 237 leaders of teams who joined 18 different QICs to measure changes in working methods and activities, overall perceived success, team organisation, and supportive conditions. Actual outcomes were extracted from a database with team performance indicator data. Multi-level analyses were conducted to test a number of hypothesised relations within the cross-classified hierarchical structure in which teams are nested within QICs and hospitals.</p> <p>Results</p> <p>Organisational and external change agent support is related positively to the number of changed working methods and activities that, if increased, lead to higher perceived success and indicator outcomes scores. Direct and indirect positive relations between conditions and perceived success could be confirmed. Relations between conditions and actual outcomes are weak. Multi-level analyses reveal significant differences in organisational support between hospitals. The relation between perceived successes and actual outcomes is present at QIC level but not at team level.</p> <p>Discussion</p> <p>Several of the expected relations between conditions, applied changes and outcomes, and perceived successes could be verified. However, because QICs vary in topic, approach, complexity, and promised advantages, further research is required: first, to understand why some QIC innovations fit better within the context of the units where they are implemented; second, to assess the influence of perceived success and actual outcomes on the further dissemination of projects over new patient groups.</p

Appraising Evidence-Based Mental Health and Psychosocial Support (MHPSS) Guidelines—PART II:A Content Analysis with Implications for Disaster Risk Reduction

High quality mental health and psychosocial support (MHPSS) guidelines are indispensable for policy and practice to address the mental health consequences of disasters. This contribution complements a review that assessed the methodological quality of 13 MHPSS guidelines. We analyzed the content of the four highest-ranking guidelines and explored implications for disaster risk reduction (DRR). A qualitative explorative thematic analysis was conducted. The four guidelines proved largely similar, overlapping or at least complementary in their MHPSS definitions, stated purpose of the guidelines, user and target groups, terminology, and models used. Many recommended MHPSS measures and interventions were found in all of the guidelines and could be assigned to five categories: basic relief, information provision, emotional and social support, practical support, and health care. The guidelines stress the importance of monitoring needs and problems, evaluating the effect of service delivery, deliberate implementation and preparation, and investments in proper conditions and effective coordination across professions, agencies, and sectors. The MHPSS knowledge base embedded in the guidelines is comprehensive, coherent, and sufficiently universal to serve as the “overarching framework” considered missing yet vital for the integration of MHPSS approaches in DRR. Although application contexts differ geographically, this common ground should allow policymakers and practitioners globally to plan, implement, and evaluate MHPSS actions contributing to DRR, ideally together with target groups

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

Assessment of the inclusion of vaccination as an intervention to reduce antimicrobial resistance in AMR national action plans:a global review

BACKGROUND: Vaccination can reduce antibiotic use by decreasing bacterial and viral infections and vaccines are highlighted in the WHO Global Action Plan on Antimicrobial Resistance (AMR) as an infection prevention measure to reduce AMR. Our study aimed to analyze whether WHO Member States have developed AMR national action plans that are aligned with the Global Action Plan regarding objectives on vaccination. METHODS: We reviewed 77 out of 90 AMR national action plans available in the WHO library that were written after publication of the Global Action Plan in 2015. Each plan was analyzed using content analysis, with a focus on vaccination and key components as defined by WHO (I. Strategic plan (e.g. goals and objectives), II. Operational plan, III. Monitoring and Evaluation plan). RESULTS: Vaccination was included in 67 of 77 AMR plans (87%) across all WHO Regions (Africa: n = 13/13, the Eastern Mediterranean: n = 15/16, Europe: n = 10/14, the Americas: n = 8/8, South-East Asia: n = 8/11, and the Western Pacific: n = 13/15). Pneumococcal and influenza vaccination were most frequently highlighted (n = 12 and n = 11). We found indications that vaccination objectives are more often included in AMR plans from higher income countries, while lower income countries more often include specific vaccines. The key WHO components of national action plans were frequently not covered (I. 47% included, II. 57%, III. 40%). In total, 33 countries (43%) included indicators (e.g. strategic objectives) to capture the role of vaccines against AMR. CONCLUSIONS: While vaccination to reduce AMR is seen as an important global public health issue by WHO, there appears to be a gap in its adoption in national AMR plans. Country income levels seem to influence the progress, implementation and focus of national action plans, guided by a lack of funding and prioritization in developing countries. To better align the global response to AMR, our review suggests there is a need to update national action plans to include objectives on vaccination with more focus on specific vaccines that impact antibiotic use