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1.
BMC Infect Dis ; 20(1): 397, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32503444

RESUMO

BACKGROUND: Primary aim of this study was to compare cognitive performance of patients with chronic Q fever or Q fever fatigue syndrome (QFS) to matched controls from the general population, while taking performance validity into account. Second, we investigated whether objective cognitive performance was related to subjective cognitive complaints or psychological wellbeing. METHODS: Cognitive functioning was assessed with a neuropsychological test battery measuring the domains of processing speed, episodic memory, working memory and executive functioning. Tests for performance validity and premorbid intelligence were also included. Validated questionnaires were administered to assess self-reported fatigue, depressive symptoms and cognitive complaints. RESULTS: In total, 30 patients with chronic Q fever, 32 with QFS and 35 controls were included. A high percentage of chronic Q fever patients showed poor performance validity (38%) compared to controls (14%, p = 0.066). After exclusion of participants showing poor performance validity, no significant differences between patients and controls were found in the cognitive domains. QFS patients reported a high level of cognitive complaints compared to controls (41.2 vs 30.4, p = 0.023). Cognitive complaints were not significantly related to cognitive performance in any of the domains for this patient group. CONCLUSIONS: The high level of self-reported cognitive complaints in QFS patients does not indicate cognitive impairment. A large proportion of the chronic Q fever patients showed suboptimal mental effort during neuropsychological assessment. More research into the underlying explanations is needed. Our findings stress the importance of assessing cognitive functioning by neuropsychological examination including performance validity, rather than only measuring subjective cognitive complaints.


Assuntos
Cognição/fisiologia , Fadiga/diagnóstico , Febre Q/diagnóstico , Adulto , Idoso , Estudos de Casos e Controles , Coxiella burnetii/isolamento & purificação , Depressão/diagnóstico , Depressão/etiologia , Fadiga/etiologia , Feminino , Humanos , Masculino , Memória Episódica , Memória de Curto Prazo , Pessoa de Meia-Idade , Testes Neuropsicológicos , Febre Q/complicações , Febre Q/microbiologia
2.
J Psychosom Res ; 121: 37-45, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31006533

RESUMO

OBJECTIVE: After Q fever infection, 1-5% of patients develop chronic Q fever, while about 20% develops Q fever fatigue syndrome (QFS). This study examines whether these two conditions have a long-term impact on psychosocial functioning compared to the general population and patients with type 2 diabetes (DM) and investigate which mediating factors influence outcomes. METHODS: Cross-sectional study was performed, measuring psychosocial functioning including quality of life (depression and satisfaction with life), anxiety, social functioning and relationship satisfaction in patients with proven or probable chronic Q fever or QFS, 5-9 years after acute Q fever infection. Multivariate linear regression was used to analyse differences between groups, correct for confounders and identify relevant mediators (fatigue, physical or cognitive functioning, illness perception). RESULTS: Quality of life and social functioning of chronic Q-fever and QFS patients was significantly lower and anxiety significantly higher compared to DM patients and the general population. The impact was completely mediated by fatigue in both Q fever groups. Physical and cognitive functioning and illness perception partially mediated the impact. CONCLUSIONS: Health care workers need to be aware of the long-term impact of chronic Q fever and QFS on psychosocial functioning of patients in order to provide proper guidance.


Assuntos
Diabetes Mellitus/psicologia , Síndrome de Fadiga Crônica/complicações , Síndrome de Fadiga Crônica/psicologia , Febre Q/complicações , Febre Q/psicologia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação Pessoal , Qualidade de Vida , Ajustamento Social , Fatores de Tempo
3.
Front Public Health ; 6: 208, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30234081

RESUMO

Background and objective: Understanding how natural disasters affect their victims is key to improve prevention and mitigation. Typhoon Haiyan strongly hit the Philippines in 2013. In Leyte, health staff of two hospitals had a key role as responders, but also as victims. Scarce literature is available on how health staff may be affected when being disasters' victims. We therefore aimed to understand Haiyan's impact for health staff at personal and work level. Methods: We conducted semi-structured interviews in the two hospitals with doctors, nurses, midwives, watchmen and administrative staff in September 2016. We used a thematic analysis. Results: The three main aspects reported as influencing staff were accessibility, safety and emotional aspects. Accessibility was a main difficulty, which prevented some staff from reaching the hospital, causing other staff staying longer on-call. Personal and family safety were affected, and due to remaining on-call immediately after Haiyan, staff members reported lack of information about their family situation. Faith was an emotional aspect repeatedly mentioned as a coping mechanism, and commitment to serve patients was for some respondents an essential argument to stay on duty. Conclusions: Conflict between personal and professional concerns was present in health staff, making it difficult for them to prioritize work. Feeling unsafe was a common experience among health staff which influenced attendance to the hospital. Including temporary housing for staff and relatives close by the hospital can improve the extensive disaster risk during the typhoon season. In addition, established communication channels should be prioritized for staff on duty to find out about family members' wellbeing. We recommend faith and commitment to serve patients to be included in the preparedness programs in this setting.

4.
Artigo em Inglês | MEDLINE | ID: mdl-28075363

RESUMO

Due to the conflict that started in spring 2014 in Eastern Ukraine, a total of 1.75 million internally displaced persons (IDPs) fled the area and have been registered in government-controlled areas of the country. This paper explores perceived health, barriers to access to healthcare, caring practices, food security, and overall financial situation of mothers and young children displaced by the conflict in Ukraine. This is a qualitative study, which collected data through semi-structured in-depth interviews with nine IDP mothers via Skype and Viber with a convenience sample of participants selected through snowball technique. Contrary to the expectations, the perceived physical health of mothers and their children was found not to be affected by conflict and displacement, while psychological distress was often reported. A weak healthcare system, Ukraine's proneness to informal payments, and heavy bureaucracy to register as an IDP were reported in our study. A precarious social safety net to IDP mothers in Ukraine, poor dietary diversity, and a generalized rupture of vaccine stocks, with halted or delayed vaccinations in children were identified. Increasing social allowances and their timely delivery to IDP mothers might be the most efficient policy measure to improve health and nutrition security. Reestablishment and sustainability of vaccine stocks in Ukraine is urgent to avoid the risks of a public health crisis. Offering psychological support for IDP mothers is recommended.


Assuntos
Saúde da Criança/estatística & dados numéricos , Abastecimento de Alimentos/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Nível de Saúde , Saúde Materna/estatística & dados numéricos , Refugiados/psicologia , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Entrevistas como Assunto , Saúde Pública , Pesquisa Qualitativa , Ucrânia , Adulto Jovem
5.
PLoS One ; 10(7): e0131848, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26161658

RESUMO

BACKGROUND: Serological follow-up of acute Q-fever patients is important for detection of chronic infection but there is no consensus on its frequency and duration. The 2007-2009 Q-fever epidemic in the Netherlands allowed for long-term follow-up of a large cohort of acute Q-fever patients. The aim of this study was to validate the current follow-up strategy targeted to identify patients with chronic Q-fever. METHODS: A cohort of adult acute Q-fever patients, diagnosed between 2007 and 2009, for whom a twelve-month follow-up sample was available, was invited to complete a questionnaire and provide a blood sample, four years after the acute episode. Antibody profiles, determined by immunofluorescence assay in serum, were investigated with a special focus on high titres of IgG antibodies against phase I of Coxiella burnetii, as these are considered indicative for possible chronic Q-fever. RESULTS: Of the invited 1,907 patients fulfilling inclusion criteria, 1,289 (67.6%) were included in the analysis. At any time during the four-year follow-up period, 58 (4.5%) patients were classified as possible, probable, or proven chronic Q-fever according to the Dutch Q-fever Consensus Group criteria (which uses IgG phase I ≥1:1,024 to as serologic criterion for chronic Q-fever). Fifty-two (89.7%) of these were identified within the first year after the acute episode. Of the six patients that were detected for the first time at four-year follow-up, five had an IgG phase I titre of 1:512 at twelve months. CONCLUSIONS: A twelve-month follow-up check after acute Q-fever is recommended as it adequately detects chronic Q-fever in patients without known risk factors. Additional serological and clinical follow-up is recommended for patients with IgG phase I ≥1:512, as they showed the highest risk to progress to chronic Q-fever.


Assuntos
Epidemias , Febre Q/sangue , Adulto , Anticorpos Antibacterianos/sangue , Coxiella burnetii/imunologia , Feminino , Seguimentos , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Febre Q/epidemiologia , Febre Q/imunologia , Inquéritos e Questionários
6.
Scand J Public Health ; 43(3): 294-301, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25724468

RESUMO

AIMS: The aim of the study was to assess long-term work participation of Q-fever patients and patients with Legionnaires' disease, and to identify which factors are associated with a reduced work participation in Q-fever patients. METHODS: Q-fever patients participated at four time points until 12 months after onset of illness, patients with Legionnaires' disease only at 12 months. Data were self-reported using questionnaires on the amount of hours that patients worked, and on socio-demographic, medical, psychosocial and lifestyle aspects. RESULTS: Our study included 336 Q-fever patients and 190 patients with Legionnaires' disease. There was a decrease in the proportion of Q-fever patients with reduced work participation over time, from 45% at 3 months to 19% at 12 months (versus 15% of patients with Legionnaires' disease at 12 months). Factors associated with reduced work participation of Q-fever patients in a multivariate model were having symptoms, a higher level of sorrow, being a former smoker (compared to never smoking), not consuming any alcohol and following additional treatment for the long-term health effects of Q-fever. CONCLUSIONS: Despite an increase in work participation of Q-fever patients over time, almost one in five Q-fever patients and one in six patients with Legionnaires' disease still suffer from reduced work participation at 12 months. Occupational and insurance physicians need to be aware of the long-term impact of these diseases on work participation.


Assuntos
Doença dos Legionários , Febre Q , Trabalho/estatística & dados numéricos , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Autorrelato , Fatores de Tempo
7.
J Infect ; 70(3): 237-46, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25452036

RESUMO

OBJECTIVES: During the largest Q-fever outbreak ever reported, a cohort study was established to assess the health status of Q-fever patients over a 24-month period and to identify factors associated with health status. METHODS: Laboratory-confirmed Q-fever patients participated at six time points after onset of illness. Scores on twelve subdomains from two health status instruments were calculated for each time point to determine progression and compare to reference groups. RESULTS: The study included 336 Q-fever patients. There is a significant linear improvement over time in nine of the twelve health status subdomains. For example, the proportion of patients with severe fatigue improved from 73.0% at three months to 60.0% at twelve months and 37.0% at twenty-four months, but this was still high compared to a healthy reference group (2.5%). For the three most severely affected subdomains -'Fatigue', 'General Quality of Life' and 'Role Physical'- the baseline characteristics significantly associated with a long-term reduced health status were being female, being a young adult and having pre-existing health problems. CONCLUSIONS: Despite a significant linear improvement over time in nine of the twelve health status subdomains, more than one out of three patients still suffered from a reduced health status at 24 months.


Assuntos
Nível de Saúde , Febre Q/complicações , Febre Q/fisiopatologia , Adulto , Estudos de Coortes , Surtos de Doenças , Fadiga , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Inquéritos e Questionários , Fatores de Tempo
8.
J Infect ; 68(6): 527-33, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24468188

RESUMO

BACKGROUND: We assessed and compared the long-term health status of Q-fever patients and patients with Legionnaires' disease. METHODS: Q-fever patients and patients with Legionnaires' disease fulfilling the Dutch notification criteria filled out a questionnaire at one year after onset of illness. The proportion of patients with an abnormal score was calculated for 12 health status subdomains and mean scores for the most relevant subdomains were compared between the patient groups. RESULTS: We included 309 Q-fever patients and 190 patients with Legionnaires' disease in the study. A large proportion of the two patient groups was negatively affected on many of the subdomains, especially 'Fatigue', 'General Quality of Life' and 'Role Physical'. We assessed health status of the patient groups using a multivariate regression analysis and found no significant difference for 'Fatigue' and 'General Quality of Life'. Only for the subdomain 'Role Physical', Q-fever patients scored significantly worse compared to patients with Legionnaires' disease. CONCLUSIONS: Many Q-fever patients and patients with Legionnaires' disease suffer from a severely affected health status on one or more subdomains at one year after onset of illness. We recommend additional support for a large proportion of both patient groups during the first year after onset of illness.


Assuntos
Disparidades nos Níveis de Saúde , Doença dos Legionários/complicações , Febre Q/complicações , Adulto , Idoso , Fadiga/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Qualidade de Vida/psicologia , Inquéritos e Questionários
9.
Health Qual Life Outcomes ; 11: 112, 2013 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-23826639

RESUMO

BACKGROUND: The aim of the study was to assess the use of the Nijmegen Clinical Screening Instrument (NCSI) and Short Form 36 (SF-36) in providing a detailed assessment of health status of Q-fever patients and to evaluate which subdomains within the NCSI and SF-36 measure unique aspects of health status. FINDINGS: Patients received a study questionnaire, which contained the NCSI and SF-36. Pearson correlation coefficients between subdomains of the instruments were calculated. The response rate was 94% (309 out of 330 eligible patients). Intercorrelations between subdomains of the NCSI were generally lower than of the SF-36. Four subdomains of the NCSI showed conceptual similarity (Pearson's r ≥ .70) with one or more subdomains of the SF-36 and vice versa. Subdomains that showed no conceptual similarity were NCSI Subjective Pulmonary Symptoms, Subjective Impairment, Dyspnoea Emotions and Satisfaction Relations, and SF-36 Social functioning, Bodily Pain, Role Physical and Role Emotional. CONCLUSIONS: Our results show that either the NCSI or SF-36 can be used to measure health status in Q-fever patients. When the aim is to obtain a detailed overview of the patients' health, a combination of the two instruments, consisting of the complete NCSI and the four unique subdomains of the SF-36, is preferred.


Assuntos
Indicadores Básicos de Saúde , Programas de Rastreamento/instrumentação , Avaliação de Processos em Cuidados de Saúde/métodos , Psicometria/instrumentação , Febre Q/psicologia , Qualidade de Vida , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Assistência Centrada no Paciente , Febre Q/diagnóstico , Reprodutibilidade dos Testes , Inquéritos e Questionários
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