title: Q-fever patients suffer from impaired health status long after the acute phase of the illness: results from a 24-month cohort study.
abstract: OBJECTIVE
  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.
authors.affiliation: Academic Collaborative Centre AMPHI, Department of Primary and Community Care, Radboud University Medical Center, The Netherlands. Electronic address: joris.vanloenhout@radboudumc.nl.
authors.forename: Joris A F
authors.initials: JA
authors.lastname: van Loenhout
authors.affiliation: Academic Collaborative Centre AMPHI, Department of Primary and Community Care, Radboud University Medical Center, The Netherlands. Electronic address: jeannine.hautvast@radboudumc.nl.
authors.forename: Jeannine L A
authors.initials: JL
authors.lastname: Hautvast
authors.affiliation: Department of Medical Psychology, Radboud University Medical Center, The Netherlands. Electronic address: jan.vercoulen@radboudumc.nl.
authors.forename: Jan H
authors.initials: JH
authors.lastname: Vercoulen
authors.affiliation: Academic Collaborative Centre AMPHI, Department of Primary and Community Care, Radboud University Medical Center, The Netherlands. Electronic address: reinier.akkermans@radboudumc.nl.
authors.forename: Reinier P
authors.initials: RP
authors.lastname: Akkermans
authors.affiliation: Academic Collaborative Centre AMPHI, Department of Primary and Community Care, Radboud University Medical Center, The Netherlands; Department of Infectious Disease Control, Municipal Health Service Hart voor Brabant, The Netherlands. Electronic address: c.wijkmans@ggdhvb.nl.
authors.forename: Clementine J
authors.initials: CJ
authors.lastname: Wijkmans
authors.affiliation: Academic Collaborative Centre AMPHI, Department of Primary and Community Care, Radboud University Medical Center, The Netherlands. Electronic address: koos.vandervelden@radboudumc.nl.
authors.forename: Koos
authors.initials: K
authors.lastname: van der Velden
authors.affiliation: Academic Collaborative Centre AMPHI, Department of Primary and Community Care, Radboud University Medical Center, The Netherlands; Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands. Electronic address: john.paget@radboudumc.nl.
authors.forename: W John
authors.initials: WJ
authors.lastname: Paget
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004196:Disease Outbreaks; D005221:Fatigue; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011778:Q Fever / Q000150:complications* / Q000503:physiopathology*; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: Coxiella burnetii; Health status; Q-fever; Quality of life