RESUMEN
The aim of this study was to gain more insight in the association between prevalence of diverse acute non-specific symptoms (NSS) and livestock density as a possible risk factor among residents of livestock-dense and non-dense regions, taking into account socio-demographic factors and psychological morbidity. Prevalence of NSS and psychological morbidity were assessed for the year 2017, based on electronic health records from 39 general practices in the Netherlands. The study group consisted of people who lived in rural areas with high numbers of livestock (n = 74093), while the control group included people in rural areas with low numbers of livestock (n = 50139). For a large portion of the study group, exposure estimates (to livestock) were calculated. Multiple logistic multilevel regression analyses were performed. Two methods were used: 1) area comparisons between study and control areas in relation to health problems, and 2) estimates of livestock exposure (to goats, poultry, pigs, and cattle) within the study area. It was found that prevalence of diarrhea, headache, sleep disturbance, respiratory symptoms, and skin problems were higher in the study group. The data suggest that there may be a protective effect of livestock exposure: in general, there was a lower risk of NSS closer to livestock (within the exposure analyses). The study suggests that the previously identified higher risk of respiratory health problems in livestock dense areas might also apply to the prevalence of various other NSS. Longitudinal research taking into account different or more individual and contextual characteristics could possibly elucidate why prevalence of NSS in closer proximity to livestock is lower compared to people who live further away, whilst a more overarching analysis indicated that living in livestock dense areas was associated with more NSS.
Asunto(s)
Ganado , Enfermedades Respiratorias , Animales , Bovinos , Aves de Corral , Prevalencia , Enfermedades Respiratorias/epidemiología , Factores de Riesgo , PorcinosRESUMEN
A cross-sectional study was performed among 2494 adults not living or working on a farm to assess prevalence of Clostridium difficile (CD) colonization and risk factors in a livestock dense area. CD prevalence was 1·2%. Twenty-one persons were colonized with a toxigenic strain and nine with a non-toxigenic strain. CD-positive persons did not live closer to livestock farms than individuals negative for CD. Antibiotic exposure in the preceding 3 months was a risk factor for CD colonization (odds ratio 3·70; 95% confidence interval 1·25-10·95).
Asunto(s)
Crianza de Animales Domésticos , Clostridioides difficile/fisiología , Infecciones por Clostridium/epidemiología , Adulto , Anciano , Animales , Antibacterianos/administración & dosificación , Infecciones por Clostridium/tratamiento farmacológico , Infecciones por Clostridium/microbiología , Estudios Transversales , Femenino , Humanos , Ganado , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Prevalencia , Características de la Residencia , Factores de Riesgo , Adulto JovenRESUMEN
PURPOSE: Odor annoyance is an important environmental stressor for neighboring residents of livestock farms and may affect their quality of life and health. However, little is known about the relation between odor exposure due to livestock farming and odor annoyance. Even more, the relation between odor exposure and odor annoyance is rather complicated due to variable responses among individuals to comparable exposure levels and a large number of factors (such as age, gender, education) that may affect the relation. In this study, we (1) investigated the relation between modeled odor exposure and odor annoyance; (2) investigated whether other factors can affect this relation; and (3) compared our dose-response relation to a dose-response relation established in a previous study carried out in the Netherlands, more than 10 years ago, in order to investigate changes in odor perception and appreciation over time. METHODS: We used data from 582 respondents who participated in a questionnaire survey among neighboring residents of livestock farms in the south of the Netherlands. Odor annoyance was established by two close-ended questions in a questionnaire; odor exposure was estimated using the Stacks dispersion model. RESULTS: The results of our study indicate a statistically significant and positive relation between modeled odor exposure and reported odor annoyance from livestock farming (OR 1.92; 95 % CI 1.53-2.41). Furthermore, age, asthma, education and perceived air pollution in the environment are all related to odor annoyance, although they hardly affect the relation between estimated livestock odor exposure and reported odor annoyance. We also found relatively more odor annoyance reported among neighboring residents than in a previous study conducted in the Netherlands. CONCLUSIONS: We found a strong relation between modeled odor exposure and odor annoyance. However, due to some uncertainties and small number of studies on this topic, further research and replication of results is recommended.
Asunto(s)
Crianza de Animales Domésticos , Exposición por Inhalación , Ganado , Odorantes , Características de la Residencia , Adulto , Contaminación del Aire , Animales , Asma/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos Teóricos , Países Bajos , Percepción Olfatoria , Calidad de VidaRESUMEN
BACKGROUND: Publichealth care providers, stakeholders and policy makers request a rapid insight into health status and needs of the affected population after disasters. To our knowledge, there is no standardized rapid assessment tool for European countries. The aim of this article is to describe existing tools used internationally and analyze them for the development of a workable rapid assessment. METHODS: A review was conducted, including original studies concerning a rapid health and/or needs assessment. The studies used were published between 1980 and 2009. The electronic databasesof Medline, Embase, SciSearch and Psychinfo were used. RESULTS: Thirty-three studies were included for this review. The majority of the studies was of US origin and in most cases related to natural disasters, especially concerning the weather. In eighteen studies an assessment was conducted using a structured questionnaire, eleven studies used registries and four used both methods. Questionnaires were primarily used to asses the health needs, while data records were used to assess the health status of disaster victims. CONCLUSIONS: Methods most commonly used were face to face interviews and data extracted from existing registries. Ideally, a rapid assessment tool is needed which does not add to the burden of disaster victims. In this perspective, the use of existing medical registries in combination with a brief questionnaire in the aftermath of disasters is the most promising. Since there is an increasing need for such a tool this approach needs further examination.
Asunto(s)
Desastres , Evaluación de Necesidades , Europa (Continente) , Humanos , Entrevistas como Asunto , Sistema de Registros/estadística & datos numéricos , Encuestas y CuestionariosRESUMEN
BACKGROUND: Although symptoms such as fatigue, headache and pain in bones and muscles are common after disasters, risk factors for these symptoms among disaster survivors have rarely been studied. We examined predisposing, precipitating and perpetuating factors for these physical symptoms among survivors of a man-made disaster. In addition, we examined whether risk factors for physical symptoms differ between survivors and controls. METHOD: Survivors completed a questionnaire 3 weeks (n=1567), 18 months and 4 years after the disaster. Symptoms and risk factors were measured using validated questionnaires. A comparison group was included at waves 2 and 3 (n=821). Random coefficient analysis (RCA) was used to study risk factors for symptoms. RESULTS: Female gender [beta (beta)=1.0, 95% confidence interval (CI) 0.6-1.4], immigrant status (beta=1.0, 95% CI 0.6-1.4) and pre-disaster psychological problems (beta=0.8, 95% CI 0.1-1.4) were predisposing factors for symptoms. Although disaster-related factors were predictors, the relationship between symptoms and disaster-related factors was not very strong and the magnitude of this association was reduced when perpetuating factors were added. Intrusions and avoidance, depression, anxiety and sleeping problems were important perpetuating factors for physical symptoms among survivors and mediated the association between traumatic stress and physical symptoms. Risk factors for symptoms were comparable between survivors and controls. CONCLUSIONS: The results indicate that health-care workers should be alert for physical symptoms among female survivors, immigrant survivors and individuals with a high level of psychological problems both before and after a disaster.
Asunto(s)
Explosiones , Trastornos Somatomorfos/epidemiología , Trastornos por Estrés Postraumático/epidemiología , Sobrevivientes/psicología , Adaptación Psicológica , Trastornos de Ansiedad/diagnóstico , Trastornos de Ansiedad/epidemiología , Trastornos de Ansiedad/psicología , Estudios Transversales , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/epidemiología , Trastorno Depresivo/psicología , Emigrantes e Inmigrantes/psicología , Femenino , Estudios de Seguimiento , Humanos , Estudios Longitudinales , Masculino , Países Bajos , Análisis de Regresión , Factores de Riesgo , Factores Sexuales , Trastornos del Sueño-Vigilia/diagnóstico , Trastornos del Sueño-Vigilia/epidemiología , Trastornos del Sueño-Vigilia/psicología , Trastornos Somatomorfos/diagnóstico , Trastornos Somatomorfos/psicología , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/psicología , Encuestas y CuestionariosRESUMEN
OBJECTIVES: Benzodiazepines are typically prescribed for anxiety and insomnia, two complaints often reported after disasters. Benzodiazepines can cause mental or physical dependence, especially when taken for a long time. This study aims at evaluating benzodiazepine use in a disaster-stricken community with the help of computer-based records. STUDY DESIGN AND SETTING: This prospective cohort study covers a period of 4 years. For every patient, predisaster baseline data are available. Multilevel regression is applied to study differences in benzodiazepine use in 496 patients whose children were involved in the Volendam café fire on January 1, 2001 compared with 1,709 community controls, and 4,530 patients from an unaffected cohort. RESULTS: In community controls and patients from the unaffected cohort, benzodiazepine use remained stable in the course of the years. In the first year postfire, parents of disaster victims were 1.58 times more likely to use benzodiazepines than community controls (95% confidence interval 1.13-2.23). With regard to long-term use, differences between community controls and parents were statistically nonsignificant. CONCLUSIONS: In the studied community, benzodiazepines were predominantly prescribed as a short-term intervention. Clinical guidelines that advocate a conservative prescription policy were well adhered to.
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Ansiolíticos/uso terapéutico , Ansiedad/tratamiento farmacológico , Benzodiazepinas/uso terapéutico , Incendios , Trastornos del Inicio y del Mantenimiento del Sueño/tratamiento farmacológico , Adulto , Estudios de Casos y Controles , Intervalos de Confianza , Recolección de Datos/métodos , Esquema de Medicación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Padres , Estudios Prospectivos , Análisis de Regresión , Riesgo , Trastornos Relacionados con Sustancias/prevención & controlRESUMEN
BACKGROUND: On 13 May 2000 a firework depot situated in a residential area in the Netherlands exploded. Many rescue workers were involved in the aftermath of this explosion. AIMS: To examine the longitudinal course of psychological, musculoskeletal, and respiratory problems and sickness absence among rescue workers involved. METHODS: The study population was composed of 1036 rescue workers. Data on health and sickness absence both before and after the disaster were collected from the electronic database of the rescue workers' occupational physicians. Health problems were coded according to an adapted version of the ICD-10. RESULTS: After the disaster a long term increase was found in psychological, musculoskeletal, and respiratory problems. Compared to six months before the disaster, the average length of sickness absence in the first half year after the disaster increased from 6.6 to 11.6 days, and decreased slowly in the following six month periods. CONCLUSIONS: Rescue workers involved in a disaster may experience subsequent impairment in occupational functioning.
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Desastres , Trastornos Mentales/etiología , Enfermedades Musculoesqueléticas/etiología , Enfermedades Profesionales/etiología , Trabajo de Rescate , Trastornos Respiratorios/etiología , Absentismo , Adulto , Distribución de Chi-Cuadrado , Explosiones , Femenino , Humanos , Estudios Longitudinales , Masculino , Países Bajos , Ausencia por Enfermedad/estadística & datos numéricos , Estrés Psicológico/complicacionesRESUMEN
OBJECTIVE: To perform a cost study of the first general practitioner (GP) hospital in the Netherlands. METHODS: We conducted a cost study in a GP hospital in the Netherlands. Data on healthcare utilisation from 218 patients were collected for a period of one year. The costs of admission to the GP hospital were compared with the expected costs of the alternative mode of care. In the GP hospital three types of bed categories were distinguished: GP beds (admission and discharge by GPs, n=131), rehabilitation beds (recovery from hospital surgery, n=62) and nursing home beds (hospital patients awaiting a vacancy in a nursing home, n=25). GPs were interviewed to indicate the best alternative form of healthcare for the GP bed patients in the absence of a GP hospital (dichotomised for this study into "hospital" or "home care"). For the "rehabilitation" and "nursing home" patients the alternative care mode was admission to a hospital. RESULTS: The mean length of stay was 15 days for the GP beds, 31 days for the rehabilitation beds and 90 days for the nursing home beds. For the GP bed patients the costs were 2533 euros per admission compared with 3792 euros for hospital stay. For the group of GP bed patients for whom "home care" was the best alternative, the costs were 2494 euros for GP hospital days compared with 2814euros , the average cost for home care of patients of 65 years and older. For rehabilitation patients the costs per patient were 4744 euros compared with 8041 euros in a hospital. For patients waiting for admission to a nursing home, these costs were 13,143 euros and 22,670 euros respectively. CONCLUSION: The GP hospital might be a cost-saving alternative for elderly patients in need of intermediate medical and nursing care between hospital and home care. Further research on the cost-effectiveness of the GP hospital compared with home care and nursing home care is needed.
Asunto(s)
Precios de Hospital , Costos de Hospital , Hospitales Comunitarios/economía , Anciano , Costos y Análisis de Costo , Medicina Familiar y Comunitaria , Femenino , Servicios de Atención de Salud a Domicilio/economía , Humanos , Tiempo de Internación , Masculino , Países BajosRESUMEN
BACKGROUND: An HIV-specific version of the QUOTE questionnaire was developed to measure the quality of care of patients infected with HIV from the patients' perspective. The consistency and validity of the questionnaire was assessed. METHODS: Focus group discussions were held to select aspects for inclusion in the questionnaire that are important to patients with HIV. Item and inter-item analysis, factor analysis, and reliability analysis were performed to test the internal consistency and validity of the questionnaire. RESULTS: Twenty seven items (13 generic and 14 HIV specific) were used in the QUOTE-HIV questionnaire. Separate factor analyses of the generic and HIV specific aspects indicated that each loaded onto a single factor. The internal consistency of the total questionnaire was good (Cronbach's alpha >/=0.80). Feasibility of the questionnaire was shown by the diversity of importance and performance scores for general practitioners as well as for HIV specialists and AIDS nursing consultants. CONCLUSION: The QUOTE-HIV questionnaire is a useful instrument for measuring the quality of care from the perspective of HIV infected patients.
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Infecciones por VIH/terapia , Satisfacción del Paciente/estadística & datos numéricos , Calidad de la Atención de Salud/estadística & datos numéricos , Encuestas y Cuestionarios/normas , Adulto , Estudios de Factibilidad , Femenino , Grupos Focales , Investigación sobre Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , Países Bajos , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: On 4 October 1992, an El Al Boeing 747-F cargo aeroplane crashed on two apartment buildings in Amsterdam. Thirty-nine residents on the ground and the four crew members of the plane died. In the years after, a gradually increasing number of people attributed physical signs and symptoms to their presence at the disaster scene. AIM: To investigate the consistency between patients' symptoms attributed to the crash and GPs' diagnoses and perception of the association with the crash. DESIGN OF STUDY: Comparison between self-reported symptoms to a call centre and GPs' medical records on onset and type of symptoms, diagnoses, and GPs' perception of association with the disaster, assessed by questionnaire. SETTING: Consenting patients (n = 621) contacting the call centre and their GPs. METHOD: Patients were interviewed by the call centre staff and interview data were recorded on a database. Questionnaires were sent to the consenting patients' GPs, requesting their opinions on whether or not their patients' symptoms were attributable to the effects of disaster. Baseline differences and differences in reported symptoms between interviewed patients and their GP records were tested using the chi2 test. RESULTS: The 553 responders reported on average 4.3 symptoms to the call centre. The majority of these symptoms (74%) were reported to the GP. Of the ten most commonly reported symptoms, fatigue, skin complaints, feeling anxious or nervous, dyspnoea, and backache featured in 80% of symptoms reported to the GP. One out of four symptoms was either reported to the GP before the disaster took place, or six or more years after (1998/1999, during a period of much media attention). Depression (7%), post-traumatic stress disorder (PTSD) (5%) and eczema (5%) were most frequently diagnosed by GPs. They related 6% of all reported symptoms to the disaster. CONCLUSIONS: Most of the symptoms attributed to a disaster by patients have been reported to their GP, who related only a small proportion of these to the disaster.
Asunto(s)
Accidentes de Aviación/psicología , Registros Médicos , Trastornos por Estrés Postraumático/psicología , Actitud del Personal de Salud , Medicina Familiar y Comunitaria , Humanos , Países Bajos , Trastornos por Estrés Postraumático/diagnósticoRESUMEN
BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) have repeatedly been characterised as a population of chronically ill patients with a higher than normal prevalence of depression. Susceptibility for depression has been noted in patients with certain other chronic conditions. This systematic review was conducted to achieve a more definite answer to the question: do patients with COPD show a higher than normal prevalence of depression? METHODS: Studies in English language journals were retrieved by an electronic search over the period from 1966 to December 1997 and by an extended search of reference lists, and were included or excluded according to a system of diagnostic and methodological criteria. RESULTS: Ten studies were included, of which only four had a case-control design. Three of the case-control studies reported an increased prevalence of depression among patients with COPD which was statistically significant in only one. The fourth controlled study found a significantly increased depression score among COPD patients. Of the remaining six uncontrolled studies three found a high baseline prevalence of depression among their study group. CONCLUSIONS: An association between COPD and depression was found in the four controlled studies. The two methodologically best conducted studies that did not detect a statistically significant higher prevalence lacked power. The two studies that did find a significant association used a questionable depression measure. The prevalence of depression was high compared with general population figures in three of six non-controlled studies. The empirical evidence for a significant risk of depression in patients with COPD remains inconclusive, due to the poor methodological quality of most of the published studies, the lack of studies with an adequate sample size, and variability in instruments and cut off scores used to measure depression.