The burden of COPD in the Netherlands: results from the confronting COPD survey

AbstractChronic obstructive pulmonary disease (COPD) is a disabling condition associated with progressive airflow limitation that is largely irreversible, with symptoms of dyspnoea, cough and sputum production. In the Netherlands, COPD tends to be underpresented to physicians, underdiagnosed and undertreated by healthcare professionals, and poorly recognized among the general population. Improving the diagnosis and management of COPD in this country may require raised awareness of the impact of the disease on society. This may be achieved by providing detailed information on the burden of COPD on the patient, healthcare system and the economy. This information has now become available from Confronting COPD in North America and Europe, the first international survey to quantify the country-specific impact of the disease. An economic analysis of the results of the Dutch survey revealed the high cost of COPD to the healthcare system and society, with direct costs estimated at ϵ614 per patient. Indirect costs amounted to ϵ410, bringing the annual per patient cost of COPD to ϵ1024. Around 50% of the cost of COPD to the healthcare system was for prescription medication, including symptomatic medication and treatment for underlying airway inflammation. This contributed to effective symptom control in many patients, as shown by the low utilization of unscheduled healthcare (inpatient hospitalizations, emergency room visits, or contacts with healthcare professionals). However, the survey suggested that there was scope for improvement in the understanding of the origin and consequences of this disease among the general public, and the way COPD is managed by healthcare professionals, in order to increase the proportion of patients who are diagnosed with COPD and treated in accordance with management guidelines. In addition, smoking cessation intervention at the early stages of the disease could help to reduce the high costs associated with severe COPD in this country

Total free living energy expenditure in patients with severe chronic obstructive pulmonary disease.

Department of Pulmonology, University of Limburg, Maastricht, the Netherlands. Resting energy expenditure (REE) is often elevated in patients with chronic obstructive pulmonary disease (COPD), but no data are available regarding total energy expenditure in free living conditions. We compared total daily energy expenditure (TDE) in eight COPD patients (FEV1 36 +/- 13%) admitted to a pulmonary rehabilitation center and eight independently living healthy subjects, matched for sex, age, and body mass index (BMI). TDE was measured over a 2-wk interval using doubly labeled water in combination with measurement of REE and body composition. The COPD patients had a significantly higher TDE than the healthy subjects (2,499 +/- 320 kcal/d and 2,107 +/- 88 kcal/d, respectively, p < 0.01). The nonresting component of TDE (TDE-REE: physical activity and diet-induced thermogenesis [DIT]) was significantly higher in the COPD patients than in the healthy subjects, resulting in a ratio between TDE and REE of 1.7 +/- 0.2 and 1.4 +/- 0.1, respectively (p < 0.01). The results indicate that COPD patients exhibit an increased TDE in comparison with healthy subjects. The difference could by attributed to an increase in the nonresting component of TDE, since REE was comparable between the groups. Publication Types: Clinical Trial Controlled Clinical Tria

Lucasfilm e oltre. Tecnologia per il racconto.

La tesi vuole dimostrare le finalita' creative della ricerca tecnologica della Lucasfilm e del suo ramo per gli effetti visivi Industrial Light and Magic. Nel primo capitolo si percorre l'inizio di carriera di George Lucas e i relativi rapporti con la tecnologia, fino a Star Wars; si prosegue con l'analisi di alcune tecniche usate a inizio anni ottanta, con traduzioni proprie da T. G. Smith, Industrial Light & Magic: The Art of Special Effects, New York, Del Ray, 1986. Nel secondo capitolo si analizzano i primi inserimenti nel cinema della tecnologia elettronica e informatica, con traduzioni proprie da M. Rubin, Droidmaker: George Lucas and the Digital Revolution, Gainesville, Triad, 2005. Nel terzo capitolo si analizza lo sviluppo e l'uso delle nuove tecnologie digitali, in particolare l'alta definizione e l'animazione al computer, da parte della Lucasfilm per il cinema, la televisione e i videogiochi. L'apparato di appendici copre la filmografia Lucasfilm, i titoli non-Lucasfilm strettamente correlati agli argomenti trattati, i principali titoli per cui la ILM ha curato gli effetti speciali; una ludografia con i videogiochi usciti sotto il marchio Lucasfilm Games e LucasArts; una videografia con i documentari di riferimento (contenuti nei cofanetti dvd dei film); una bibliografia internazionale

The health-related quality of life of obese persons seeking or not seeking surgical or non-surgical treatment:A meta-analysis

Background: A meta-analysis examined differences in health-related quality of life (HRQoL) between seekers of surgical and non-surgical treatment, and non-treatment seekers, over and above differences that are explained by weight, age, and gender. Methods: Our literature search focused on the 'Impact of Weight on Quality of Life-Lite' (IWQOL-Lite) and the 'Short Form-36' (SF-36) questionnaires. Included were studies published between 1980 and April 2006 providing (pre-treatment) descriptive statistics of adult overweight or (morbid) obese persons. Excluded were elderly and ill patient groups. Results: Fifty-four articles, with a total number of nearly 100.000 participants, met the inclusion criteria. Persons seeking surgical treatment demonstrated the most severely reduced HRQoL. IWQOL-Lite scores showed larger differences between populations than SF-36 scores. After adjustment for weight, the population differences on the IWQOL disappeared. In contrast, the differences on the SF-36 between the surgical treatment seeking population and the other populations were maintained after adjustment for weight. Conclusion: The IWQOL-Lite questionnaire predominantly reflects weight-related HRQoL, whereas the SF-36 mostly reflects generic HRQoL that is determined by both weight and other factors. Our meta-analysis provides reference values that are useful when explicating or evaluating obesity-specific (IWQOL-Lite) or generic (SF-36) HRQoL, weight, and demographic characteristics of obese persons seeking or not seeking surgical or non-surgical treatment

Striking similarities in systemic factors contributing to decreased exercise capacity in patients with severe chronic heart failure or COPD

Striking similarities in systemic factors contributing to decreased exercise capacity in patients with severe chronic heart failure or COPD. Gosker HR, Lencer NH, Franssen FM, van der Vusse GJ, Wouters EF, Schols AM. Department of Pulmonology, University of Maastricht, the Netherlands. [email protected] AIMS: Chronic heart failure (CHF) and COPD are both characterized by muscular impairment. To assess whether the severity and functional consequences of muscular impairment are disease specific, we compared skeletal muscle function, body composition, and daily activity level relative to exercise capacity between these two disorders. METHODS: Twenty-five patients with CHF and 25 patients with COPD, and 36 healthy gender- and age-matched control subjects underwent measurement of fat-free mass (FFM) [by bioelectrical impedance analysis] as an index of muscle mass. Quadriceps and biceps functions were tested by isokinetic methods, and daily activity level was assessed by the Physical Activity Scale for Elderly (PASE) questionnaire. Peak oxygen consumption (O(2)peak) was measured by incremental cycle ergometry. RESULTS: PASE results were similar in patients with CHF and in patients with COPD, each group scoring lower than control subjects. FFM was also lower in patients than control subjects and correlated closely with quadriceps and biceps strength in all three subgroups, R values ranging from 0.63 to 0.78, with identical slopes. FFM also correlated significantly with O(2)peak (p < 0.05), but slopes were less steep in patients than in control subjects. The type and severity of muscle dysfunction were similar in each group of patients. There were no significant correlations between indexes of cardiopulmonary function and muscle function or exercise performance in patients with CHF or in patients with COPD. In both control subjects and patients, FFM was the most significant determinant of O(2)peak. CONCLUSION: Muscle dysfunction is not limited to the lower limbs, but generalized and comparable between patients with CHF and patients with COPD with similar exercise capacity. FFM is a strong predictor of peripheral muscle strength, to a lesser extent of O(2)peak, and not at all of peripheral muscle enduranc