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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).
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.
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.
Female gender [beta (β)=1.0, 95% confidence interval (CI) 0.6–1.4], immigrant status (β=1.0, 95% CI 0.6–1.4) and pre-disaster psychological problems (β=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.
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.
There are few prospective studies on risk factors for health problems
after disasters in which actual pre-disaster health data are
To examine whether survivors' personal characteristics, and pre-disaster
psychological problems, and disaster-related variables, are related to
their post-disaster health.
Two studies were combined: a longitudinal survey using the electronic
medical records of survivors' general practitioners (GPs), from 1 year
before to 1 year after the disaster, and a survey in which questionnaires
were filled in by survivors, 3 weeks and 18 months after the disaster.
Data from both surveys and the electronic medical records were available
for 994 survivors.
After adjustment for demographic and disaster-related variables,
pre-existing psychological problems were significantly associated with
post-disaster self-reported health problems and post-disaster problems
presented to the GP. This association was found for both psychological
and physical post-disaster problems.
In trying to prevent long-term health consequences after disaster, early
attention to survivors with pre-existing psychological problems, and to
those survivors who are forced to relocate or are exposed to many
stressors during the disaster, appears appropriate.
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