Prevention Of Harm Research Articles

Gambling policy positions of Finnish newspapers between 2004 and 2020: An automated content analysis

Aims: The media can influence gambling policy formation and public opinion. Previous research has established that the tension between political or public interest in gambling revenue and gambling harm is fundamental for understanding gambling policy. There are two opposing gambling policy positions: (1) gambling revenue or the economic benefits of gambling, and (2) the harmful impacts of gambling. This study is the first study to estimate these gambling policy positions of newspapers on a common scale. The objective is to estimate how the gambling policy positions of major Finnish daily newspapers evolved between 2004 and 2020. This knowledge deepens our understanding about the changes in the relative balance between harm and revenue in gambling policy. Methods and data: The data consisted of newspaper editorials (N = 58) on gambling policy from five major Finnish daily newspapers between 2004 and 2020. The data were analysed with the automated content analysis algorithm Wordfish. Results: The results show that there has been a clear shift in the gambling policy positions of the major Finnish newspapers towards increased acknowledgement of the importance of prevention and reduction of gambling harm. Conclusions: Due to the interplay between the media, politics, and the public, it is likely that the importance of prevention and reduction of gambling harm will be recognised and addressed to a larger extent when gambling policy is formulated in Finland in the future. More generally, if the gambling policy positions of media and other stakeholders change, this can facilitate a promotion of harm prevention policies.

"Drugs and alcohol get talked about, why not betting?" Young men's qualitative insights about strategies to prevent gambling harm.

Research is needed to understand young people's perspectives about public health promotion strategies relevant for their health and wellbeing. This study provides suggestions from young male gamblers about sports betting harm prevention and reduction strategies. In-depth interviews were conducted with 16 young men aged 18 to 24 years, from Melbourne, Victoria, who regularly engaged in sports betting. A critical qualitative inquiry approach, using methods of constructivist grounded theory guided the study. Reflexive thematic analysis was used to interpret and construct themes from the data. Participants indicated three main harm prevention strategies. These were online consumer protection and regulatory strategies, public education campaigns that highlighted sports betting risks and harms and the creation of formal and informal support networks to reduce stigma and encourage help seeking. They also supported being engaged in the development of harm prevention strategies and suggested ways to help reduce barriers to engagement. Young men recognise the need for regulatory, education and engagement responses to counter the risks posed by new gambling products. Young men may be difficult to engage in formal prevention activities, however, youth-led and informal interactive mechanisms may help to overcome this barrier, and contribute to a comprehensive public health approach to gambling harm prevention. SO WHAT?: Young men can draw upon their lived experiences of gambling to provide insights relevant for public health promotion. Mechanisms should be developed to engage young people in the co-production of strategies and policies aimed at gambling harm prevention and reduction.

Calibrating states' emissions reduction due diligence obligations with reference to the right to life

AbstractThe 2017 Advisory Opinion of the Inter‐American Court of Human Rights broke new ground in finding that States' failure to regulate with due diligence the activities taking place within its territory could constitute a breach of the human rights of persons located elsewhere. How might this finding inform the law on prevention of transboundary harm? Similarly, how might it inform an identification of the standard of care required of States in respect of climate change? This article argues that the law on transboundary harm should now be understood as requiring States to regulate the reduction of greenhouse gas emissions in accordance with stabilizing global warming at a temperature, which, at a minimum, prevents widespread threat to life around the globe. States' differing capacities to invest in mitigation strategies, their varying historic contributions to climate change and the urgency of reducing greenhouse gas emissions are also factors affecting a reasonable standard of care.

Association Between Hospital-Acquired Harm Outcomes and Membership in a National Patient Safety Collaborative

Hospital engagement networks supported by the US Centers for Medicare & Medicaid Services Partnership for Patients program have reported significant reductions in hospital-acquired harm, but methodological limitations and lack of peer review have led to persistent questions about the effectiveness of this approach. To evaluate associations between membership in Children's Hospitals' Solutions for Patient Safety (SPS), a federally funded hospital engagement network, and hospital-acquired harm using standardized definitions and secular trend adjustment. This prospective hospital cohort study included 99 children's hospitals. Using interrupted time series analyses with staggered intervention introduction, immediate and postimplementation changes in hospital-acquired harm rates were analyzed, with adjustment for preexisting secular trends. Outcomes were further evaluated by early-adopting (n = 73) and late-adopting (n = 26) cohorts. Hospitals implemented harm prevention bundles, reported outcomes and bundle compliance using standard definitions to the network monthly, participated in learning events, and implemented a broad safety culture program. Hospitals received regular reports on their comparative performance. Outcomes for 8 hospital-acquired conditions were evaluated over 1 year before and 3 years after intervention. In total, 99 hospitals met the inclusion criteria and were included in the analysis. A total of 73 were considered part of the early-adopting cohort (joined between 2012-2013) and 26 were considered part of the late-adopting cohort (joined between 2014-2016). A total of 42 hospitals were freestanding children's hospitals, and 57 were children's hospitals within hospital or health systems. The implementation of SPS was associated with an improvement in hospital-acquired condition rates in 3 of the 8 conditions after accounting for secular trends. Membership in the SPS was associated with an immediate reduction in central catheter-associated bloodstream infections (coefficient = -0.152; 95% CI, -0.213 to -0.019) and falls of moderate or greater severity (coefficient = -0.331; 95% CI, -0.594 to -0.069). The implementation of the SPS was associated with a reduction in the monthly rate of adverse drug events (coefficient = -0.021; 95% CI, -0.034 to -0.008) in the post-SPS period. The study team observed larger decreases for the early-adopting cohort compared with the late-adopting cohort. Through the application of rigorous methods (standard definitions and longitudinal time series analysis with adjustment for secular trends), this study provides a more thorough analysis of the association between the Partnership for Patients hospital engagement network model and reductions in hospital-acquired conditions. These findings strengthen previous claims of an association between this model and improvement. However, inconsistent observations across hospital-acquired conditions when adjusted for secular trends suggests that some caution regarding attributing all effects observed to this model is warranted.

Using meconium to establish prenatal alcohol exposure in the UK: ethical, legal and social considerations

An expanding policy framework aimed at monitoring alcohol consumption during pregnancy has emerged. The primary justification is prevention of harm from what is termed ‘prenatal alcohol exposure’ (PAE), by enabling...

“Frantic online searches for help”: design considerations for an online early intervention service addressing harmful sexual behaviour

ABSTRACT Secondary prevention efforts, which target risk and protective factors associated with harmful sexual behaviour (HSB) and seek to intervene early in the trajectory of HSB, are underdeveloped in Australia. This study explored design considerations for an online early intervention service for children and young people worried about their sexual thoughts and behaviours. A trauma-informed child right’s framework underpinned the study, which involved 10 individual interviews with international experts in HSB, and one group interview (n = 3) with Australian practitioners. Analysis was carried out using thematic analysis. Results reflect design considerations in relation to: theoretical approaches; practice frameworks; service delivery components; and helpseeking challenges. Key tensions emerging from the results are discussed, including the need to move beyond binary constructions of victims and perpetrators. PRACTICE IMPACT STATEMENT: This paper has significant potential to influence practice in the field of harmful sexual behaviour prevention and response. The paper sets out the components of an early intervention online service for children and young people worried about their sexual thoughts and behaviours. The online service could be built and trialed for impact and efficacy in supporting children and young people not to sexually harm. It would be the first service of its kind in Australia and fill a gap in the current service delivery landscape.

Connecting Through Dance: Understanding Conscious Clubbing Event Experiences.

Individuals abstaining from alcohol consumption frequently find themselves in contexts encouraging consumption, with limited alternative social interaction opportunities. Conscious clubbing events exclude alcohol and drugs, possibly providing valuable social connections, but little is known about event benefits. Twelve conscious clubbing event attendees and facilitators aged 25-55 from across Europe participated in semi-structured photo-elicitation interviews, which were analysed using thematic analysis. Findings suggested that conscious clubbing appears to enhance health, healing and growth, aiding recovery from substance dependency and trauma. Positioned as a modern ritual, symbolic and ritualistic preparations and experiences promoted storytelling and self-discovery. Connecting through synchronised but unchoreographed movement, participants engaged in powerful journeys and transformative experiences detached from life constraints. Inclusive digital and face-to-face conscious clubbing communities provided a sense of meaning and belonging away from substance use pressures and harms, particularly for those marginalised within society. Findings provide important and in-depth insights, including novel harm prevention implications. Future work should consider participatory barriers, event sustainability and misconceptions to increase event availability and participation.

“We were building the plane as we were flying it, and we somehow made it to the other end”: syringe service program staff experiences and well-being during the COVID-19 pandemic

BackgroundSyringe service programs (SSPs) provide essential harm reduction and prevention services for people who inject drugs in the USA, where SSP coverage is expanding. During the COVID-19 pandemic, US SSPs underwent unprecedented shifts in operational procedures (e.g., closures of physical sites, staff redeployment into pandemic response efforts). Given the critical role of US SSP workers in the pandemic, we sought to explore the occupational experiences and well-being of SSP staff to inform future emergency response efforts.MethodsFrom July–October 2020, we conducted semi-structured interviews with staff members of four SSPs in diverse regions of Massachusetts. Trained interviewers administered qualitative interviews virtually. Interviews were coded in NVivo v12 and thematic analysis identified common occupational experiences and related impacts on staff well-being in the context of the COVID-19 pandemic.ResultsAmong 18 participants, 12 (67%) had client-facing roles such as harm reduction specialists and six (33%) worked in program management or leadership. We found that staff were frequently anxious about SARS-CoV-2 transmission, which contributed to staff turnover. SSPs rapidly adapted and expanded their services to meet increasing client needs during the pandemic (e.g., food distribution, COVID-19 testing), leading to staff overexertion. Simultaneously, public health measures such as physical distancing led to staff concerns about reduced social connections with clients and coworkers. Through these challenges, SSPs worked to protect staff well-being by implementing flexible and tangible COVID-19-related policies (e.g., paid sick leave), mental health resources, and frequent communication regarding pandemic-related operational changes.ConclusionSSPs in the USA adapted to the COVID-19 pandemic out of necessity, resulting in operational changes that threatened staff well-being. Despite the protective factors revealed in some narratives, our findings suggest that during prolonged, complex public health emergencies, SSPs may benefit from enhanced occupational supports to prevent burnout and promote wellness for this essential public health workforce.

Prevalence of HIV Preexposure Prophylaxis Prescribing Among Persons With Commercial Insurance and Likely Injection Drug Use

Although HIV preexposure prophylaxis (PrEP) implementation among persons who inject drugs has been inadequate, national HIV monitoring programs do not include data on PrEP, and specific trends in PrEP use are not well understood. To estimate HIV PrEP uptake among commercially insured persons with opioid or stimulant use disorder by injection drug use (IDU) status. This cross-sectional study used deidentified data from the MarketScan Commercial Claims and Encounters Database to identify a sample of 547 709 commercially insured persons without HIV but with opioid and/or stimulant use disorder, including 110 592 with evidence of IDU between January 1, 2010, and December 31, 2019. Data were analyzed from November 1, 2020, to July 1, 2021. Persons with opioid and/or stimulant use disorder and evidence of IDU were identified through claims data. The outcome was receipt of tenofovir disoproxil fumarate and emtricitabine for PrEP as identified from filled pharmacy claims. Multivariable logistic regression was used to assess the association of demographic and clinical characteristics with receipt of PrEP. The study cohort included 211 609 (28.6%) females and 336 100 (61.4%) males with a combined mean (SD) age of 34.8 (13.1) years, including 110 592 individuals with evidence of IDU. During the study period, 508 (0.09%) persons with opioid and/or stimulant use disorder, including 170 (0.15%) with evidence of IDU, received PrEP. Receipt of PrEP increased from 0.001 to 0.243 per 100 person-years from 2010 through 2019 among the entire cohort and from 0.000 to 0.295 per 100 person-years among those with IDU. In multivariable analysis, PrEP use was more likely among males (adjusted odds ratio [aOR] 8.72; 95% CI, 6.39-11.89), persons with evidence of IDU (aOR, 1.47; 95% CI, 1.21-1.79), and persons with evidence of sexual risk indications for PrEP (aOR, 23.68; 95% CI, 19.57-28.66). In this cross-sectional study of commercially insured persons with opioid and/or stimulant use disorder, HIV PrEP delivery remained low, including among those with evidence of IDU. PrEP should be consistently offered alongside substance use disorder treatment and other harm reduction and HIV prevention services.

Nurses' harm prevention practices during admission of an older person to the hospital: A multi-method qualitative study.

Nurses' harm prevention practices during the admission of older persons to hospital have important consequences for patient safety, preventable patient harm and length of hospital stay. Novel solutions are needed to assist nurses to balance complexity, high workload burden and patient safety during admission processes. Explore the nurses' experiences of harm prevention practices during the admission of an older person to the hospital. A multi-method qualitative study informed by frameworks of behaviour change and human-centred co-design. The purposive sample included 44 nurses, 5 clinicians from other disciplines and 3 consumers recruited from five general medicine wards across three hospitals of a large public health service in metropolitan Melbourne, Australia. Data were collected over 12h of naturalistic observations of nurses during eight patient admissions, and during four participatory human-centred co-design workshops between August 2019 and January 2020. Observation, field notes and workshop artefact data were integrated for qualitative content and thematic analysis. Analysis revealed a 5-step journey map, with a temporal logic, that captured nurses' experiences, as well as the enablers and barriers to harm prevention practices when admitting an older person to the hospital. The consensus was reached on three priority features to assist nurses to implement harm prevention practices when they admit an older person to the hospital: (1) prioritize important care; (2) tailor care to the individual and (3) see the big picture for the patient. The novel research approach identified five steps in nurses' activities and harm prevention practices during admission of an older person to the hospital, and key features for a solution to assist nurses to keep patients safe. The findings provide the foundation for further research to develop interventions to assist nurses to manage high workloads during this complex activity.

Differences Between Illegal and Legal Gamblers in Israel: Gambling Behavior, Motivation, and Substance Use.

Little is known about people who gamble in illegal settings, and the extent of differences in gambling behavior between legal and illegal gamblers is unclear. The present study examined the characteristics of illegal gamblers and whether they engage in more frequent and severe gambling behaviors, and demonstrate greater motivation for gambling and substance use than legal gamblers. A cross-sectional online survey recruited 1251 people who gambled in the preceding year, of whom 13% (N = 161) participated in illegal gambling. Significant differences were found in gambling behaviors between illegal and legal gamblers in all outcomes examined. People who participated in illegal gambling reported more frequent participation in almost all types of legal gambling, more types of "multi-bets," more severe and high-risk gambling behaviors, higher motivations to gamble, and higher frequencies of substance use than those who engaged in legal gambling. Logistic regressions revealed that the stronger associations with illegal gambling were among problem gamblers (OR = 17.80; CI 9.21-34.4; p < 0.000), among the age group of 29-41years (OR = 6.16; CI 3.15-12.3; p < 0.000), among moderate-risk gamblers (OR = 5.54; CI 3.42-3.42; p < 0.000) and among secular individuals (OR = 4.11; CI 1.73-9.77; p ≤ 0.001). A comprehensive gambling policy is needed in Israel to address illegal gambling. The policy should attend to harm reduction, treatment, prevention, and enforcement. Additionally, more studies are needed to examine gambling behavior and other risk behaviors of illegal gamblers.

Research Capacity and Needs for Alcohol-Related Harm Prevention in West Africa: Findings From a Cross-Sectional Survey of Stakeholders

The purpose of this study was to determine capacity and resource needs for alcohol prevention research among stakeholders across nine countries in West Africa. We analyzed a cross-sectional survey conducted in the fall of 2020, distributed by the West African Alcohol Policy Alliance to their member alliances and stakeholders across nine countries in West Africa. Fifteen survey questions assessed research capacity and priorities related to alcohol prevention and harm locally and in the region. Overall, 140 persons participated in the survey, predominantly representing community-based organizations (CBOs) and nongovernmental organizations (NGOs). Only 42% of the respondents reported that their organizations have conducted research with a university or a research institution (with percentages ranging from 13% in Burkina Faso to 68% in Nigeria). The survey respondents indicated greater capacity for "upstream" research tasks (e.g., monitoring and evaluation, online survey tools, and data collection) compared with "downstream" research tasks (e.g., data analyses, translating research for community use, and preparing policy briefs and briefing decision makers). Less than half (48%) of the respondents were familiar with the World Health Organization (WHO) SAFER initiative. Given the low proportion of stakeholders in alcohol-related work who have worked with universities and research institutions, a clear priority is to facilitate and strengthen future collaborations. In addition, improving capacity for downstream research tasks is needed to inform policy. Finally, increasing familiarity with SAFER among key stakeholders involved in alcohol harm prevention in the region is a tangible short-term priority.

DINAMIKA POLITIK IDENTITAS DAN DINASTI DI INDONESIA: Menuju Politik yang Ideal Melalui Eksplorasi Teori Maslahah

This research aims to explore the dynamics of identity politics and dynasties in Indonesia and efforts to present ideal politics. This study uses a literature review, adopts a qualitative research approach, and applies descriptive analysis techniques based on Maslahah's theory. The results show that identity politics and dynasties play a significant role in the formation of power, often relying on ethnic, religious, or family identity to mobilise support, which can increase the representation of certain groups but also trigger polarisation and erode the principles of democracy and meritocracy. The interaction between identity politics and dynasties creates complexities in political dynamics that can hinder the achievement of an ideal politics based on democracy, justice and equality. On the other hand, efforts towards ideal politics in Indonesia must involve a strong commitment to the principles of democracy, justice and equality, strengthening the foundations of inclusive and participatory democracy, ensuring free and fair elections, and building political awareness and political education among the people. Eradicating corruption, collusion, and nepotism is also a top priority in creating clean politics and integrity. In addition, nurturing diversity and pluralism is an essential step in creating a more inclusive and democratic society. A Maslahah theory-based analysis also emphasises the achievement of the common good and the prevention of harm, which are essential in guiding Indonesia towards ideal politics. It includes empowering individuals and groups in society, promoting social justice, and maintaining social harmony. As such, this study makes an essential contribution to the understanding of identity and dynastic politics in Indonesia and the steps needed to achieve a more equitable and inclusive politics.

Exploring post-hoc agnostic models for explainable cooking recipe recommendations

The need of increasing trustworthiness and transparency in artificial intelligence (AI)-based systems that adhere ethical principles of respect for human autonomy, prevention of harm, fairness, and explainability; has boosting the development of systems that incorporate such issues as a key component. Recommender systems (RSs) are included in such AI-based systems, because they use intelligent algorithms for providing the most suitable items to active users according to other users’ preferences. The RSs success is based on how much customers trust on the system, therefore recommendation explainability has become a crucial dimension for RSs adoption in real-world scenarios. Among the different successful applications of RS, it is remarkable the recent and exponential importance of recommendations for health and wellness areas. Hence, this paper aims at exploring, adapting and applying explanations for nutrition/recipes recommendations, that not only explain why the recommendation is enjoyable but also, it is aware of how healthy is the recommendation. Among the different methodologies to explain recommendations, this paper is focused on post-hoc explainability approaches and its adaptation, application and evaluation for nutrition/recipes recommendation. Eventually, it is included a comprehensive experimental study for characterizing the strengths and weaknesses of such explainability approaches in the recipe recommendation context.

SAMHSA funding drives harm reduction activities

Although many people are still confused about what “harm reduction” means (overdose prevention centers where people can inject heroin? free naloxone and fentanyl test strips? low barrier methadone and buprenorphine treatment? and so on) the federal government views only naloxone, fentanyl test strips, and syringe services programs as fundable. However, the Substance Abuse and Mental Health Services Administration (SAMHSA), which has announced a $30 million grant for harm reduction, described it succinctly: Access to PrEP, a medication which reduces sexually transmitted HIV, as well as to all HIV and HPV testing, are part of harm reduction. So is access to condoms and “comprehensive sex education.” SAMHSA views these tools, which are by no means new, as harm reduction prevention goals. Likewise, reducing overdose deaths by providing naloxone to reverse opioid overdoses is a priority. Masks, safe smoking supplies (such as safe crack pipes), and stigma reduction are also key. Peers who are in recovery can be supported with this. Stay tuned to find out how the $30 million to $10 million a year over three years in grant funding will be used by states and grantees. The harm reduction community, which was ecstatic about the grants at first, became annoyed when it appeared that there was an application process which was viewed as cumbersome and which would result in only the big players winning awards (see “SAMHSA announces harm‐reduction grants,” ADAW Dec. 13, 2021; https://onlinelibrary.wiley.com/doi/10.1002/adaw.33290).

Different dimensions of wellness in drug addiction treatment

IntroductionAccording to the World Health Organisation goals of treatment of drug addiction are: reducing of drug use and craving, improving of health, well-being and social functioning of the affected individual, prevention of future harms by decreasing the risk of complications and relapse. Wellness means a sense of overall well-being incorporating numerous aspects of an individual’s life. These include physical, mental, emotional, intellectual, occupational, and spiritual aspects. For those who suffer from mental and substance use disorders, wellness means feeling a sense of purpose in life, being actively involved in work or play that is satisfying, finding happiness, having joyful relationships, and having a healthy body and living environment. .ObjectivesWe will present different dimensions of wellness and describe how to incorporate these dimensions into drug addiction treatment.MethodsPresentation of theoretical frame and description of treatment programme at the Center for Treatment of Drug Addiction Ljubljana.ResultsWhen each of wellness dimensions is balanced, it is easier to maintain recovery process and avoid the triggers of relapse.ConclusionsIn the context of wellness, treatment goal is to maximize the capacity of person to feel, think and act in ways that enhance his/her ability to enjoy life and deal with the challenges he/she face. Wellness lifestyle includes a balance of health habits such as adequate sleep and rest, productivity, exercise, participation in meaningful activity, nutrition, productivity, social contact, and supportive relationships.DisclosureNo significant relationships.

Minimizing sample bias due to stigmatized behaviours: the representativeness of participants in a cohort study of alcohol in pregnancy

BackgroundStigmatized behaviours are often underreported, especially in pregnancy, making them challenging to address. The Alcohol and Child Development Study (ACDS) seeks to inform prevention of foetal alcohol harm, linking self-report as well as a maternal blood alcohol biomarker with child developmental outcomes. Samples were requested using passive, generic consent. The success of this approach at minimizing bias is presented comparing characteristics of women who provided samples to those who did not.MethodsAll pregnant women in the study city were sent a Patient Information Sheet (PIS) with their first NHS obstetric appointment letter. The PIS informed them that the NHS would like to take an extra blood sample for research purposes, unless they opted out. Neither the women nor the midwives were informed that the samples might be tested for an alcohol biomarker. This paper examines the extent to which women who provided the extra sample were representative of women where no sample was provided, in terms of routinely collected information: age; body mass index; area-based deprivation; previous pregnancies, abortions and caesarians; smoking status and carbon monoxide level; self-reported alcohol use, gestation and birth weight of their baby. Chi-square and Mann-Whitney U tests were used to compare groups.Results3436 (85%) of the 4049 pregnant women who attended their appointment provided the extra sample. Women who did not were significantly younger (p < 0.001), more materially deprived (p < 0.001), and less likely to be considered for intervention based on self-reported alcohol use (p < 0.001). There were no significant differences between the two groups on other routine data.ConclusionsThe use of passive consent without disclosure of the specific research focus resulted in a high level of sample provision. There was no evidence that study blinding was breached, and women who provided a sample were more likely to report alcohol consumption. Passive consent to draw additional blood for research purposes at routine antenatal venipuncture reduced sampling bias compared to asking women to give blood for an alcohol study. This methodology may be useful for other stigmatised behaviours.

A readiness assessment for the prevention of alcohol-related harm in West Africa: A new methodological approach to inform practice and policy.

Alcohol-related harm is a growing concern globally and particularly in West Africa. However, tools for assessing the readiness for prevention of alcohol-related harm in low-resource settings have been lacking. We modified the WHO tool, the Readiness Assessment for the Prevention of Child Maltreatment Short Form (RAP-CM), to assess readiness for the prevention of alcohol-related harm across West Africa. We conducted a cross-sectional survey in the fall of 2020, distributed by the West Africa Alcohol Policy Alliance to their member alliances and stakeholders, predominantly community-based organizations (CBOs) and non-governmental organizations (NGOs), across 7 countries in West Africa (N=140). The survey included modified measures from the RAP-CM short form. In terms of general readiness, the overall adjusted aggregate score for West Africa was 45.0% (ranging from 42.9% in Liberia to 52.7% in Senegal). Of the ten domains assessed (on a 0-10 scale), across all countries, knowledge of alcohol-related harm prevention (8.3) and legislation, mandates, and policies (6.7) received the highest readiness scores. The lowest readiness scores were observed for human and technical resources (2.5), attitudes toward preventing alcohol-related harm (2.7), and the will to address the problem (2.9). Our results demonstrate substantial variability across domains in the readiness to address alcohol-related harm with clear strengths and limitations for future priority setting and capacity building. The barriers to progress include attitudes toward alcohol-related harm prevention, lack of willingness to address the problem, and limited human and technical resources available. These barriers need to be mitigated to address the high burden of alcohol-related harm in the region and to inform both practice and policy.

Compensation Claims in Danish Emergency Care: Identifying Hot Spots and Blind Spots in the Quality of Care.

The Healthcare Complaints Analysis Tool (HCAT) offers a validated way of systematically extracting content from patient complaints for further analysis of complaint hot spots with harm or near misses, and blind spots with, for example, systemic problems or quality problems arising during discharge. This study analyzed a Danish national sample of compensations claims about emergency care using the HCAT. Through use of the HCAT, compensation claims about Danish emergency care from 2013 to 2017 (N = 712) were coded and then grouped to identify and highlight hot spot problem areas (harm and near misses) and blind spot problem areas (admission/discharge, systemic problems, errors of omission). Two assessors coded the compensation claims by entering data into a database. The HCAT analyses of the sample resulted in coding of 1,305 problems. Most problems concerned quality and safety issues at the examination/diagnosis stage of care (63.9%). In 91.2% of the cases, the level of harm was moderate or major. Harm hot spots most often involved diagnostic errors (189 problems). Eighty-nine problems related to errors of omission, all causing moderate or major harm. For systemic blind spots, patient harm significantly increased in cases of multiple problem types in the compensation claim (odds ratio = 1.6, 95% confidence interval = 1.3-2.0). Systematic coding and analytic approach to the HCAT can highlight potential quality problems in emergency care and point to areas for further consideration. From the perspective of future health care harm prevention, there seems to be a strong incentive for further analysis of the amount, nature, and prevention of diagnostic errors in emergency care.

“This Pandemic Has Opened Another Box of War”: COVID-19, Safeguarding, and Research on Human Trafficking and Modern Slavery in Kenya and Uganda

ABSTRACT There is growing evidence of the significant impacts of COVID-19 and government responses for those who experience human trafficking and modern slavery (HTMS). There is less known about experiences of service-providers, effects on international partnerships, and the implications of funder responses. This article uses the prism of safeguarding to explore the challenges faced during the pandemic for service-providers in Kenya and Uganda, paying attention to the power dynamics embedded within international development and knowledge production. The research included interviews conducted with a diverse set of organizations in 2020 and 2021. Our findings contribute to human rights approaches to HTMS, laying bare the effects of the pandemic on shared meanings around protection and harm prevention. The analysis identifies fresh challenges and additional risks that research on the effects of COVID-19 on HTMS places on local fieldworkers and research participants. The discussion emphasizes the dangers of opportunistic research, and the importance of addressing local needs as a focus and priority. The article concludes by arguing that the centering of safeguarding should be the basis for future strategy to address SDG8.7, with potential to provide a pathway for genuinely collaborative research that foregrounds equity in both partnership-building and knowledge production.