The SMILE study: a study of medical information and lifestyles in Eindhoven, the rationale and contents of a large prospective dynamic cohort study

<p>Abstract</p> <p>Background</p> <p>Health problems, health behavior, and the consequences of bad health are often intertwined. There is a growing need among physicians, researchers and policy makers to obtain a comprehensive insight into the mutual influences of different health related, institutional and environmental concepts and their collective developmental processes over time.</p> <p>Methods/Design</p> <p>SMILE is a large prospective cohort study, focusing on a broad range of aspects of disease, health and lifestyles of people living in Eindhoven, the Netherlands. This study is unique in its kind, because two data collection strategies are combined: first data on morbidity, mortality, medication prescriptions, and use of care facilities are continuously registered using electronic medical records in nine primary health care centers. Data are extracted regularly on an anonymous basis. Secondly, information about lifestyles and the determinants of (ill) health, sociodemographic, psychological and sociological characteristics and consequences of chronic disease are gathered on a regular basis by means of extensive patient questionnaires. The target population consisted of over 30,000 patients aged 12 years and older enrolled in the participating primary health care centers.</p> <p>Discussion</p> <p>Despite our relatively low response rates, we trust that, because of the longitudinal character of the study and the high absolute number of participants, our database contains a valuable set of information.</p> <p>SMILE is a longitudinal cohort with a long follow-up period (15 years). The long follow-up and the unique combination of the two data collection strategies will enable us to disentangle causal relationships. Furthermore, patient-reported characteristics can be related to self-reported health, as well as to more validated physician registered morbidity. Finally, this population can be used as a sampling frame for intervention studies. Sampling can either be based on the presence of certain diseases, or on specific lifestyles or other patient characteristics.</p

Rapport VII. c-2. Dynamique d’un canal à eau bouillante

This study sets out to determine the criteria governing the critical instability condition for a boiling water channel. A certain number of known analogy models describing such systems are analysed and an improved model presented. The transfer functions for an open circuit are calculated and used to define the conditions under which instability appears in natural-convection or forced-circulation systems. It is shown that the same function determines these conditions in both cases. Hydraulic instability in a forced circulation system is connected with the characteristics of the boiling channel itself, whereas in a natural convection system, the feedback mechanism between the mass flow and vacuum rate plays a very important part. The theoretical results obtained are compared with experimental data from the authors’ laboratory.Le but de cette étude est la détermination des critères pour les seuils d’instabilité d’un canal à eau bouillante. Un certain nombre de modèles analogiques connus décrivant de tels systèmes sont analysés et un modèle amélioré est présenté. Les fonctions de transfert d’un circuit ouvert sont calculées et elles sont utilisées à définir les conditions dans lesquelles les instabilités se présentent dans des systèmes à convection naturelle ou a circulation forcée. On démontre que la même fonction détermine ces conditions dans les deux cas. Dans un système à circulation forcée l’instabilité hydraulique est reliée aux caractéristiques du canal bouillant même, tandis que dans le régime à convection naturelle le mécanisme du «feed-back » entre le débit massique et le taux de vide joue un rôle très important. Les résultats théoriques obtenus sont comparés avec ceux d’expériences exécutées dans ce laboratoire.Verheugen A. N. J., Spigt C. L., Bogaardt M. Rapport VII. c-2. Dynamique d’un canal à eau bouillante. In: Le rôle de la mécanique des fluides dans les progrès récents des techniques. 1967

Les phénomènes accompagnant le début de l’instabilité de l’écoulement dans les canaux verticaux bouillants

An experimental study of incipient hydrodynamic instability in a vertical boiling channel. Attempted definition of a standard reference for incipient instability, based on auto-correlations and power/density curves. Establishment of instability characteristics by voids fraction detectors measuring impedance at various levels. Occurrence of instability depending on pressure and subcooling at the channel intake. Flow patterns in a boiling water loop at atmospheric conditions.Dans ce rapport sont présentés les résultats d'une étude expérimentale de l'apparition des instabilités hydrodynamiques dans un canal à ébullition vertical. Un effort a été fait pour décrire une norme pour l'apparition des instabilités utilisant des auto-corrélations et des courbes de puissance-densité. Le caractère des instabilités a été étudié par des détecteurs de la fraction de vide posés à différentes hauteurs mesurant l'impédance. L'apparition des instabilités est présentée en fonction de la pression et du sous-refroidissement à l'entrée du canal. Des configurations d'écoulement observées dans une boucle de l'eau bouillante atmosphérique sont montrées.Spigt C. L., Dijkman F. J. M., Bogaardt M. Les phénomènes accompagnant le début de l’instabilité de l’écoulement dans les canaux verticaux bouillants. In: Les instabilités en hydraulique et en mécanique des fluides. Compte rendu des huitièmes journées de l'hydraulique. Lille, 8-10 juin 1964. Tome 2, 1965

Primary and secondary care clinicians’ views on self-treatment of COPD exacerbations: A multinational qualitative study

OBJECTIVE: To explore clinicians' views on antibiotic and/or steroid 'rescue packs' used as self-treatment for patients with exacerbations of COPD. METHODS: 21 focus groups conducted in 7 countries--Netherlands, Russia, Norway, China (Hong Kong), Wales, Germany and Poland involving 142 primary care clinicians and pulmonologists. RESULTS: We found wide variation in reported use of and attitudes to self-treatment among GPs and pulmonologists in the participating countries. Clinicians highlighted the importance of identifying patients who were most likely to benefit (those with more severe disease) and most likely to use the treatment appropriately (demonstrated by previous behaviour), and the importance of adequate patient education and ongoing communication in regard to use of self-treatment packs. Clinicians recognised patient empowerment and facilitating prompt treatment as potential benefits of self-treatment. However, many felt they did not have the time or resources for appropriate patient selection and education. CONCLUSION: Clinicians do not feel it is appropriate to offer self-treatment rescue packs to all patients routinely without careful consideration of patient understanding of their illness and their capacity for self-management. PRACTICE IMPLICATIONS: Adequate resources and continuity of patient care are required for clinicians to feel confident in the safe and effective implementation of this strategy