Onze leef- en werkomgeving heeft invloed op onze gezondheid, maar het nauwkeurig bepalen van persoonlijke blootstelling aan verschillende milieufactoren blijft een uitdaging. Toch is dit wel van belang, omdat bijvoorbeeld de blootstelling aan fijnstof, stikstofdioxide en ozon jaarlijks al leidt tot 12.000 vroegtijdige sterfgevallen in Nederland (Gezondheidsraad, 2018). In werkomgevingen zijn er behalve voor de genoemde stoffen ook nog andere vluchtig organische stoffen en chemicalen waarvan de blootstelling op de korte of lange termijn tot negatieve gezondheidseffecten kan leiden. Ook fysische blootstellingen kunnen negatieve gezondheidseffecten hebben, zoals geluid, UV-straling, elektromagnetische velden en trillingen.
Full text beschikbaar met HU-account. Sinds de opkomst van sociale media spelen de toepassing en het bereik ervan in toenemende mate een rol, ook bij rampen en crises. De vraag rijst dan hoe daar in de crisiscommunicatie en het crisismanagement effectief mee om te gaan. Uit literatuuronderzoek en een analyse van een viertal Nederlandse casus blijkt dat, hoewel sommige officiële instanties nog steeds verrast kunnen worden door de snelle stroom van berichten en de effecten die dat met zich meebrengt, er al veel is geleerd over het omgaan met en benutten van sociale media in crisissituaties. Professionals dealing with crises are more or less forced to a next level of crisis communication and crisis management. This is because of the influence of social media. Messages on Twitter, Facebook and other social media can have a significant impact on the course of developments during a crisis. Sometimes in a positive way, when help is mobilized quickly and people can be informed almost instantly. On other occasions the impact is more negative, when for instance rumors lead to false accusations or threats. In the past several years, crisis management authorities have built up more experience with the use and application of social media and monitoring tools. There are still cases where officials and professionals are taken by surprise because of the shift stream of messages and their impact on public opinion and crisis control. But also lessons have been learned, e.g. in terms of online and offline reactions, cooperation with the public, and rumor control. This article gives an overview of research results in literature and summarizes the outcomes of a case study research project
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Background: Multimodal prehabilitation programs are effective at reducing complications after colorectal surgery in patients with a high risk of postoperative complications due to low aerobic capacity and/or malnutrition. However, high implementation fidelity is needed to achieve these effects in real-life practice. This study aimed to investigate the implementation fidelity of an evidence-based prehabilitation program in the real-life context of a Dutch regional hospital.Methods: In this observational cohort study with multiple case analyses, all patients who underwent colorectal surgery from January 2023 to June 2023 were enrolled. Patients meeting the criteria for low aerobic capacity or malnutrition were advised to participate in a prehabilitation program. According to recent scientific insights and the local care context, this program consisted of four exercise modalities and three nutrition modalities. Implementation fidelity was investigated by evaluating: (1) coverage (participation rate), (2) duration (number of days between the start of prehabilitation and surgery), (3) content (delivery of prescribed intervention modalities), and (4) frequency (attendance of sessions and compliance with prescribed parameters). An aggregated percentage of content and frequency was calculated to determine overall adherence.Results: Fifty-eight patients intended to follow the prehabilitation care pathway, of which 41 performed a preoperative risk assessment (coverage 80%). Ten patients (24%) were identified as high-risk and participated in the prehabilitation program (duration of 33-84 days). Adherence was high (84-100%) in five and moderate (72-73%) in two patients. Adherence was remarkably low (25%, 53%, 54%) in three patients who struggled to execute the prehabilitation program due to multiple physical and cognitive impairments.Conclusion: Implementation fidelity of an evidence-based multimodal prehabilitation program for high-risk patients preparing for colorectal surgery in real-life practice was moderate because adherence was high for most patients, but low for some patients. Patients with low adherence had multiple impairments, with consequences for their preparation for surgery. For healthcare professionals, it is recommended to pay attention to high-risk patients with multiple impairments and further personalize the prehabilitation program. More knowledge about identifying and treating high-risk patients is needed to provide evidence-based recommendations and to obtain higher effectiveness.
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