title: Health problems in children and adolescents before and after a man-made disaster.
abstract: OBJECTIVE
  The aims of this study were to examine health problems of children (4-12 years old at the time of the disaster) and adolescents (13-18 years old at the time of the disaster) before and after exposure to a fireworks disaster in the Netherlands (May 2000), to compare these health problems with a control group, and to identify risk factors for postdisaster psychological problems.
  
  
  METHODS
  Because the electronic medical records of family practitioners were used, longitudinal monitoring of health problems from 1 year predisaster until 2 years postdisaster for both victims (N=1,628) and controls (N=2,856) was possible. Health problems were classified according to the International Classification of Primary Care.
  
  
  RESULTS
  Postdisaster increases were significantly larger in victims than in controls for psychological problems, musculoskeletal problems, stress reactions, and symptoms of the extremities. Children 4-12 years old presented larger increases in sleep problems compared with controls, whereas children 13-18 years old showed larger increases in anxiety problems than their controls. Significant predictors for postdisaster psychological problems included being relocated, presenting predisaster psychological problems, and a low to medium socioeconomic status.
  
  
  CONCLUSIONS
  Children and adolescents exposed to a disaster are at risk of long-lasting increases in both psychological and physical health problems. Postdisaster interventions should focus on those who were relocated and presented predisaster psychological problems.
authors.affiliation: All of the authors are with The Netherlands Institute for Health Services Research (NIVEL), Utrecht.. Electronic address: a.dirkzwager@nivel.nl.
authors.forename: Anja J E
authors.initials: AJE
authors.lastname: Dirkzwager
authors.affiliation: All of the authors are with The Netherlands Institute for Health Services Research (NIVEL), Utrecht.
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Kerssens
authors.affiliation: All of the authors are with The Netherlands Institute for Health Services Research (NIVEL), Utrecht.
authors.forename: C Joris
authors.initials: CJ
authors.lastname: Yzermans
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005194:Family Practice / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D023481:Terrorism / Q000523:psychology* / Q000706:statistics & numerical data*; D013997:Time Factors