RESUMO
Background: Extremely violent events such as terrorist attacks and mass shootings form a severe risk for the health and wellbeing of affected individuals. In this study based on a public health monitor, we focus on the health impact (including PTSD symptoms, physical problems and day-to-day functioning) of the Utrecht tram shooting, which took place in the morning of March 18th 2019. A lone gunman opened fire on passengers within a moving tram. Four people died, and six people were injured in this attack. The attack resulted in nationwide commotion and drew much media attention. Aim of this study was to increase insight into the health effects for the survivors (those directly impacted by a terrorist attack and the bereaved), and whether they received the needed care and support. Methods: Semi-structured interviews with accompanying questionnaires were conducted at six and 18 months post-attack. Overall, 21 survivors (victims/witnesses and loved ones of deceased victims) participated in the first series of interviews, 15 in the second series. Qualitative data were analyzed using reflexive thematic analysis, quantitative data was only described because of the low sample size. Results: At both six and 18 months after the attack many survivors had been able to resume daily life, and most rated their overall health as (very) good or excellent. At the same time, a substantial portion suffered from health problems such as posttraumatic stress symptoms and other complaints, and needed professional care. Furthermore, those in need did not always find their own way to appropriate care through the existing health system: half of the survivors still needed support in finding the right care 18 months later. Conclusion: Although the design and implementation of this public health monitor were accompanied by multiple challenges, it was possible to track a portion of the survivors and gain insight in the considerable health burden of the attack. Also, it is clear in this study that the health impact of terrorism affects survivors in the long run and requires attention from health authorities and professionals, as survivors were not able to find the right care by themselves.
RESUMO
BACKGROUND: To assess the prevalence of negative body image and weight loss behaviour among children in primary and secondary school. METHODS: Data were collected during the routine health assessment, in 10,767 children in the 6th grade (9-10 years) of primary school and the 2nd grade (13-14 years) of secondary school in Utrecht, a province in The Netherlands. Weight loss behaviour and body image were assessed during an interview and weight and height were measured. RESULTS: A total of 7.8% of the boys and 13.9% of the girls of primary school had a negative body image (P < 0.001); 2.9% of the boys and 6.9% girls found themselves too fat, while having a normal body weight (P < 0.001). Weight-loss behaviour is found in 3.7% of the boys and 7.0% of the girls (P < 0.001). At secondary school, 15.8% of the boys and 32.5% of the girls found themselves too fat (P < 0.001). A total of 8.6% of the boys and 27.5% of the girls found themselves too fat, while having a normal body weight (P < 0.001); 4.7% of the boys and 12.9% of the girls with a normal weight showed weight loss behaviour (P < 0.001). CONCLUSION: A negative body image and weight loss behaviour were already present in 9- to 10-year-old children and among children with a normal weight in The Netherlands. Among secondary school children (13-14 year), the prevalence of a negative body image and of weight loss behaviour was high, especially for girls. Diagnostic tools are needed for youth health-care workers to detect unnecessary weight loss behaviour.
