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      Psychosocial care responses to terrorist attacks: a country case study of Norway, France and Belgium

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          Abstract

          Background

          The international terrorism threat urges societies to invest in the planning and organization of psychosocial care. With the aim to contribute to cross-national learning, this study describes the content, target populations and providers of psychosocial care to civilians after terrorist attacks in Norway, France and Belgium.

          Methods

          We identified and reviewed pre- and post-attack policy documents, guidelines, reports and other relevant grey literature addressing the psychosocial care response to terrorist attacks in Oslo/Utøya, Norway on 22 July 2011; in Paris, France on 13 November 2015; and in Brussels, Belgium on 22 March 2016.

          Results

          In Norway, there was a primary care based approach with multidisciplinary crisis teams in the local municipalities. In response to the terrorist attacks, there were proactive follow-up programs within primary care and occupational health services with screenings of target groups throughout a year. In France, there was a national network of specialized emergency psychosocial units primarily consisting of psychiatrists, psychologists and psychiatric nurses organized by the regional health agencies. They provided psychological support the first month including guidance for long-term healthcare, but there were no systematic screening programs after the acute phase. In Belgium, there were psychosocial intervention networks in the local municipalities, yet the acute psychosocial care was coordinated at a federal level. A reception centre was organized to provide acute psychosocial care, but there were no reported public long-term psychosocial care initiatives in response to the attacks.

          Conclusions

          Psychosocial care responses, especially long-term follow-up activities, differed substantially between countries. Models for registration of affected individuals, monitoring of their health and continuous evaluation of countries’ psychosocial care provision incorporated in international guidelines may strengthen public health responses to mass-casualty incidents.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12913-022-07691-2.

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          Most cited references56

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          Five essential elements of immediate and mid-term mass trauma intervention: empirical evidence.

          Given the devastation caused by disasters and mass violence, it is critical that intervention policy be based on the most updated research findings. However, to date, no evidence-based consensus has been reached supporting a clear set of recommendations for intervention during the immediate and the mid-term post mass trauma phases. Because it is unlikely that there will be evidence in the near or mid-term future from clinical trials that cover the diversity of disaster and mass violence circumstances, we assembled a worldwide panel of experts on the study and treatment of those exposed to disaster and mass violence to extrapolate from related fields of research, and to gain consensus on intervention principles. We identified five empirically supported intervention principles that should be used to guide and inform intervention and prevention efforts at the early to mid-term stages. These are promoting: 1) a sense of safety, 2) calming, 3) a sense of self- and community efficacy, 4) connectedness, and 5) hope.
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            Searching and synthesising ‘grey literature’ and ‘grey information’ in public health: critical reflections on three case studies

            Background Grey literature includes a range of documents not controlled by commercial publishing organisations. This means that grey literature can be difficult to search and retrieve for evidence synthesis. Much knowledge and evidence in public health, and other fields, accumulates from innovation in practice. This knowledge may not even be of sufficient formality to meet the definition of grey literature. We term this knowledge ‘grey information’. Grey information may be even harder to search for and retrieve than grey literature. Methods On three previous occasions, we have attempted to systematically search for and synthesise public health grey literature and information—both to summarise the extent and nature of particular classes of interventions and to synthesise results of evaluations. Here, we briefly describe these three ‘case studies’ but focus on our post hoc critical reflections on searching for and synthesising grey literature and information garnered from our experiences of these case studies. We believe these reflections will be useful to future researchers working in this area. Results Issues discussed include search methods, searching efficiency, replicability of searches, data management, data extraction, assessing study ‘quality’, data synthesis, time and resources, and differentiating evidence synthesis from primary research. Conclusions Information on applied public health research questions relating to the nature and range of public health interventions, as well as many evaluations of these interventions, may be predominantly, or only, held in grey literature and grey information. Evidence syntheses on these topics need, therefore, to embrace grey literature and information. Many typical systematic review methods for searching, appraising, managing, and synthesising the evidence base can be adapted for use with grey literature and information. Evidence synthesisers should carefully consider the opportunities and problems offered by including grey literature and information. Enhanced incentives for accurate recording and further methodological developments in retrieval will facilitate future syntheses of grey literature and information.
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              Continuity in general practice as predictor of mortality, acute hospitalisation, and use of out-of-hours care: a registry-based observational study in Norway

              Background Continuity, usually considered a quality aspect of primary care, is under pressure in Norway, and elsewhere. Aim To analyse the association between longitudinal continuity with a named regular general practitioner (RGP) and use of out-of-hours (OOH) services, acute hospital admission, and mortality. Design and setting Registry-based observational study in Norway covering 4 552 978 Norwegians listed with their RGPs. Method Duration of RGP–patient relationship was used as explanatory variable for the use of OOH services, acute hospital admission, and mortality in 2018. Several patient-related and RGP-related covariates were included in the analyses by individual linking to high-quality national registries. Duration of RGP–patient relationship was categorised as 1, 2–3, 4–5, 6–10, 11–15, or >15 years. Results are given as adjusted odds ratio (OR) with 95% confidence intervals (CI) resulting from multilevel logistic regression analyses. Results Compared with a 1-year RGP–patient relationship, the OR for use of OOH services decreased gradually from 0.87 (95% CI = 0.86 to 0.88) after 2–3 years’ duration to 0.70 (95% CI = 0.69 to 0.71) after >15 years. OR for acute hospital admission decreased gradually from 0.88 (95% CI = 0.86 to 0.90) after 2–3 years’ duration to 0.72 (95% CI = 0.70 to 0.73) after >15 years. OR for dying decreased gradually from 0.92 (95% CI = 0.86 to 0.98) after 2–3 years’ duration, to 0.75 (95% CI = 0.70 to 0.80) after an RGP–patient relationship of >15 years. Conclusion Length of RGP–patient relationship is significantly associated with lower use of OOH services, fewer acute hospital admissions, and lower mortality. The presence of a dose–response relationship between continuity and these outcomes indicates that the associations are causal.
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                Author and article information

                Contributors
                l.e.stene@nkvts.no
                Journal
                BMC Health Serv Res
                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central (London )
                1472-6963
                24 March 2022
                24 March 2022
                2022
                : 22
                : 390
                Affiliations
                [1 ]GRID grid.504188.0, ISNI 0000 0004 0460 5461, Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), ; Oslo, Norway
                [2 ]GRID grid.7429.8, ISNI 0000000121866389, Sorbonne Université, INSERM, Institut Pierre Louis d’épidémiologie et de Santé Publique (IPLESP), Department of social epidemiology, ; Paris, France
                [3 ]GRID grid.8767.e, ISNI 0000 0001 2290 8069, Mental Health & Wellbeing research group, , Vrije Universiteit Brussel, ; Brussels, Belgium
                [4 ]GRID grid.491097.2, ARQ National Psychotrauma Centre, ; Diemen, Netherlands
                [5 ]GRID grid.416005.6, ISNI 0000 0001 0681 4687, Netherlands Institute of Health Services Research (NIVEL), ; Utrecht, Netherlands
                [6 ]GRID grid.4830.f, ISNI 0000 0004 0407 1981, Faculty of Behavioural and Social Sciences, , University of Groningen, ; Groningen, Netherlands
                [7 ]GRID grid.5947.f, ISNI 0000 0001 1516 2393, Department of Sociology and Political Science, , Norwegian University of Science and Technology, NTNU, ; Trondheim, Norway
                [8 ]GRID grid.493975.5, ISNI 0000 0004 5948 8741, Santé publique France, ; Saint Maurice, France
                [9 ]GRID grid.412041.2, ISNI 0000 0001 2106 639X, Université Bordeaux, Inserm, UMR 1219, Vintage team, ; Bordeaux, France
                Article
                7691
                10.1186/s12913-022-07691-2
                8953389
                35331222
                7260b8cc-7aed-48ae-a4df-9656ab1d029f
                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 8 September 2021
                : 11 February 2022
                Categories
                Research
                Custom metadata
                © The Author(s) 2022

                Health & Social care
                terrorism,mass casualty incidents,crisis intervention,emergencies,psychological trauma,psychosocial interventions,health services research,mental health services,program evaluation,europe

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