1 INTRODUCCIÓN
1.1 CONCEPTOS GENERALES SOBRE ERRORES DE MEDICACIÓN
1.1.1 Terminología
with another group of pa ents with a known impaired health status.
The healthy control group was rather small with 65 individuals all over 50 years of age.
However, the number of controls provided suffi cient power for us to show a large and clear
diff erence between the groups.
Norma ve data of healthy subjects and those with COPD were only available for pa ents older than 50 years of age. This was unfortunate as 46.2% of Q-fever pa ents were younger than 50. As we chose our method to be as strict and transparent as possible, we presented data for pa ents younger and older than 50 years of age separately.
In at least 1.6% of the Q-fever pa ents in the Dutch 2007-2008 cohorts, the condi on became chronic (van der Hoek et al, submi ed for publica on). For our study popula on this could poten ally mean eight or nine pa ents with chronic Q-fever. As not all pa ents in our study were followed up serologically we were unable to establish if and who developed chronic Q-fever or any of its presenta ons such as endocardi s.
Data were collected during the early stages of the Q-fever outbreaks in the Netherlands. At that stage there was li le to no media a en on for these outbreaks. The general public was mostly unaware of Q-fever and the possible nega ve long-term outcome. Pa ents were not medicalised and mostly unaware. We therefore believe that our data were not nega vely infl uenced by the media or the general knowledge of the pa ent of the nega ve long-term outcomes.
Implica ons
By assessing the long-term health status of Q-fever pa ents of the largest outbreak in the world, we are able to describe and quan fy the impact of Q-fever on pa ent’s lives. Hospitali- sa on is an important predictor of severe illness, poor long-term health status outcome and long-term absence from work (unpublished data G.Morroy).
The outbreaks are con nuing and Q-fever has become endemic in the area. Since symp- toms could last for ten years or more [8], the burden of disease for the aff ected communi es is likely to be considerable.
A be er understanding of long-term outcomes is essen al for policy makers dealing with these outbreaks. GPs and other Medical Doctors should be aware that Q-fever pa ents may present with long-term symptoms especially in those that were hospitalised and or with co- morbidity (heart-, lung-disease, and depression). Knowledge of these detrimental long-term outcomes should help MDs to be more suppor ve to these pa ents and refer promptly and adequately to specialist care.
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Conclusions
Our study of the largest described Q-fever cohort in the world shows a large long-term im- pact of Q-fever on the health status of Q-fever pa ents of all ages. This is but an indica on of the burden of disease in the years to come considering the more than 4,000 reported Dutch Q-fever cases since 2007. Policy makers ought to take the long-term burden of disease into account, when considering measures to be taken to curb these extensive Dutch outbreaks. We recommend further research to develop adequate preven on, treatment and revalida-
on guidelines that might benefi t these aff ected pa ents.
ACKNOWLEDGEMENTS
We thank all pa ents for par cipa ng, the Municipal Health Service Brabant Zuid Oost for providing a list of pa ents and Mariska Spelthan for administra ve assistance.
REFERENCES
1. Schimmer B, Morroy G, Dijkstra F, Schneeberger PM, Weers-Pothoff G, Timen A, Wijkmans C, van der Hoek W. Large ongoing Q fever outbreak in the south of The Netherlands. Euro Surveill 2008, 31(13):18939.
2. Rijksins tuut voor Volksgezondheid en Milieuhygiëne: Q-koorts. [h p:/ / www.rivm.nl/ cib/ infec eziek- ten-A-Z/ infec eziekten/ Q_koorts/ FAQ_Q-koorts.jsp#index_1] website (accessed April 2, 2011) 3. Schimmer B, Dijkstra F, Vellema P, Schneeberger PM, Hackert V, ter Schegget R, Wijkmans C, van Duyn-
hoven Y, van der Hoek W. Sustained intensive transmission of Q-fever in the south of the Netherlands. Euro Surveill 2009, 14(19):19210.
4. A guide to Q-fever and Q-fever vaccina on 2009. CSL Biotherapies. ABN 66120398067
5. Mertens K, Samuel JE, Raoult D, Parola P. Bacteriology of Coxiella. In Ricke sial Diseases. Edited by Raoult D, Parola P. New York. Informa Healthcare; 2007:257-303.
6. Karakousis PC, Trucksis M, Dumler JS. Chronic Q-fever in the United States. J Clin Microbiol 2006, 44(6):2283-7.
7. Wilson H, Neilson G, Galea E, Staff ord G, O’Brien M. Q-fever endocardi s in Queensland. Circula on 1976, 53:680-84.
8. Wildman MJ, Smith EG, Groves J, Bea e JM, Caul EO, Ayres JG. Chronic fa gue following infec on by Coxiella burne i (Q fever): ten-year follow-up of the 1989 UK outbreak Cohort. QJM 2002, 95:527-38. 9. Ayres JG, Flint N, Smith EG, et al. Post-infec on fa gue syndrome following Q-fever. QJM 1998,
91(2):105-23.
10. Marques A. Chronic Lyme disease: a review. Infect Dis Clin North Am 2008, 22(2):341-60.
11. Marmion BP, Shannon M, Maddocks I, Storm P, Pen la I. Protracted debility and fa gue a er acute Q-fever. Lancet 1996, 347(9006):977-78.
12. Limonard GJM, Peters JB, Nabuurs-Franssen MH, Weers-Pothoff G, Besselink R, Groot CAR, Dekhuijzen PNR, Vercoulen JH. Detailed analysis of health status of Q fever pa ents 1 year a er the fi rst Dutch outbreak: a case-control study. QJM 2010, in press.
The health status of Q-fever pa ents a er long-term follow-up | 147
7
13. Wegdam-Blans MCA, Nabuurs-Franssen M, Horrevorts AM, Peeters MF, Schneeberger PM, Bijlmer HA.Laboratorium diagnos ek van acute Q-koorts. Ned Tijdschr Geneeskd 2010, 154:A238.
14. Peters JB, Daudey L, Heijdra YF, Molema J, Dekhuijzen PN, Vercoulen JH. Development of a ba ery of instruments for detailed measurement of Health Status in pa ents with COPD in rou ne care: the Nijmegen Clinical Screening Instrument. Qual Life Research 2007, 18(7):901-12.
15. Vercoulen JH, Daudey L, Molema J, Vos PJ, Peters JB, Top M, Folgering H. An Integral assessment framework of health status in chronic obstruc ve pulmonary disease (COPD). Int J Behav Med 2008, 15(4):263-79.
16. Vercoulen JHMM, Swanink CMA, Galama JMD, Fennis JFM, van der Meer JWM, Bleijenberg G. Dimen- sional assessment in chronic fa gue syndrome. J Psychosom Res 1994, 38:383-92.
17. Bergner M, Bobbi RA, Carter WB, Gilson BS. The Sickness Impact Profi le: development and fi nal revi- sion of a health status measure. Med Care 1981, 19(8):787-805.
18. Maillé AR, Koning CJ, Zwinderman AH, Willems LN, Dijkman JH, Kaptein AA. The development of the ‘Quality-of-life for Respiratory Illness Ques onnaire (QOL-RIQ)’: a disease-specifi c quality-of-life ques onnaire for pa ents with mild to moderate chronic non-specifi c lung disease. Respir Med 1997, 91(5):297-309.
19. Beck AT, Guth D, Steer RA, Ball R. Screening for major depression disorders in medical inpa ents with the Beck Depression Inventory for Primary Care. Behav Res Ther 1997, 35(8):785-91.
20. Diener E, Emmons RA, Larsen RJ, Griffi n S. The sa sfac on with life scale. Journal of Personality Assess- ment 1985, 49(1):71-5.
21. Hatche e TF, Hayes M, Merry H, Schlech WF, Marrie TJ. The eff ect of C. Burne i infec on on the quality of life of pa ents following an outbreak of Q-fever. Epidemiol Infect 2003, 130(3):491-95.
22. Pen la IA, Harris RJ, Storm P, Haynes D, Worswick DA, Marmion BP. Cytokine dysregula on in the post-Q-fever fa gue syndrome. QJM 1998, 91(8):49-60.
23. Vollmer-Conna U, Cameron B, Hadzi-Pavovic D, et al. Pos nfec ve Fa gue Syndrome Is not associated with Altered Cytokine Produc on. CID 2007, 45:732-35.
24. el Moussaoui R, Opmeer BC, de Borgie CAJM, Nieuwkerk P, Bossuyt PMM, Speelman P, Prins JM. Long- term Symptom Recovery and Health-Related Quality of Life in Pa ents With Mild-to-Moderate-Severe Community-acquired Pneumonia. Chest 2006, 130:1165-72.
25. Le nga KD, Verbon A, Nieuwkerk PT, Jonkers RE, Gersons BPR, Prins JM, Speelman P. Health-related quality of life and pos rauma c stress disorder among survivors of an outbreak of Legionnaires Dis- ease. CID 2002, 35:11-17.
26. Testa MA, Simonson DC: Assessment of Quality-of-Life Outcomes. The New England Journal of Medi- cine 1996, 334(13):835-40.
27. Lowry TJ, Pakenham KI. Health-related quality of life in chronic fa gue syndrome: Predictors of physical func oning and psychological distress. Psychol Health Med 2008, 13(2):222-38.
28. Hickie I, Davenport T, Wakefi eld D, Vollmer-Conna U, Cameron B, Vernon S, Reeves W, Lloyd A. Post- infec ve and chronic fa gue syndromes precipitated by viral and non-viral pathogens: prospec ve cohort study. BMJ 2006, 333(7568):575.
29. Fildissis G, Zidianakis V, Tsigou E, Koulen D, Katostaras T, Economou A, Baltopoulos G. Quality of life outcome of cri cal care survivors eighteen months a er discharge from intensive care. Croat Med J 2007, 48(6):814-21.
30. Juenger J, Schellberg D, Kraemer S, Haunste er, Zugck C, Herzog W, Haass M. Health related quality of life in pa ents with conges ve heart failure: comparison with other chronic diseases and rela on to func onal variables. Heart 2002, 87(3):235-41.
31. Mendes de Leon CF, Grady KL, Eaton C, Rucker-Whitaker Ch, Janssen I, Calvin J, Powell LH. Quality of life in a diverse popula on of heart failure pa ents: Baseline fi ndings from the Heart Failure Adherence and Reten on Trial (HART).J Cardiopulm Rehabil Prev 2009, 29(3):171-78.
148 | Chapter 7
32. Daudey L, Peters JB, Molema J, Dekhuijzen PN, Richard, Prins JB, Heijdra YF, Vercoulen JH. Health status in COPD cannot be measured by the St George’s Respiratory Ques onnaire alone: an evalua on of the underlying concepts of this ques onnaire. Respiratory Research 2010, 11:98.
33. Garip Y, Eser F, Bodur H. Health-related quality of life in rheumatoid arthri s: comparison of RAQoL with other scales in terms of disease ac vity, severity of pain, and func onal status. Rheumatol Int 2010, in press.
34. Beard C, Weisberg RB, Keller MB. Health-related Quality of Life across the anxiety disorders: fi ndings from a sample of primary care pa ents. J Anxiety Disord 2010, 24(6):559-64.
35. Glasgow RE, Ruggiero L, Eakin EG, Dryfoos J, Chobanian L. Quality of life and associated characteris cs in a large na onal sample of adults with diabetes. J Anxiety Disord 2010, 24(6):559-64.
36. Vercoulen JH, Swanink CM, Fennis JF, Galama JM, van der Meer JW, Blijenberg G. Dimensional assess- ment of chronic fa gue syndrome. J Psychosom Res 1994, 38(5):383-92.