Anti-stiction coating for mechanically tunable photonic crystal devices.

A method to avoid the stiction failure in nano-electro-opto-mechanical systems has been demonstrated by coating the system with an anti-stiction layer of Al2O3 grown by atomic layer deposition techniques. The device based on a double-membrane photonic crystal cavity can be reversibly operated from the pull-in back to its release status. This enables to electrically switch the wavelength of a mode over ~50 nm with a potential modulation frequency above 2 MHz. These results pave the way to reliable nano-mechanical sensors and optical switches.

[Changes between pre-crisis and crisis period in socioeconomic inequalities in health and stimulant use in Netherlands]. / Sociaal-economische gezondheidsverschillen voor en tijdens de economische crisis.

OBJECTIVE: International research suggests an impact of economic crises on population health, with different effects among different socioeconomic groups. Since the end of 2008 the Netherlands experienced a period of economic crisis. Our study explores how inequalities in perceived general and mental health, and alcohol and tobacco use changed after the recession started. DESIGN: Cross-sectional study using routinely collected data from surveys of the Dutch population. METHOD: We used data from the Dutch Health Interview Surveys: 2006-2008 (pre-crisis period) and 2009-2013 (crisis period). Respondents aged 25-64 were divided into socioeconomic groups based on labour status, income level and income change. Inequalities in health and stimulant use among these socioeconomic groups were described by period and changes between the pre-crisis and crisis period were investigated using logistic regression models. RESULTS: Most inequalities did not change, with some exceptions. For perceived general health, inequalities between employed persons and persons not in the labour force were larger in the crisis-period (unfavourable trends for those not in the labour force). For smoking, inequalities between unemployed and employed persons were larger in the crisis period (decreasing smoking rates only for those employed), as did inequalities between persons with low and high income levels (decreasing smoking rates for those with higher income levels). Excessive drinking decreased among employed persons and persons with a decrease in income, while it remained stable among persons not in the labour force and among persons with an increase in income. CONCLUSION: The widening of some socioeconomic inequalities in health and stimulant use might suggest an enhanced vulnerability of lower socioeconomic groups to the post-2008 crisis.

Electromechanical tuning of vertically-coupled photonic crystal nanobeams.

We present the design, the fabrication and the characterization of a tunable one-dimensional (1D) photonic crystal cavity (PCC) etched on two vertically-coupled GaAs nanobeams. A novel fabrication method which prevents their adhesion under capillary forces is introduced. We discuss a design to increase the flexibility of the structure and we demonstrate a large reversible and controllable electromechanical wavelength tuning (> 15 nm) of the cavity modes.

[Intelligence, socio-economic status and hospital admissions of young adults]. / Intelligentie, sociaaleconomische status en ziekenhuisopnamen van jongvolwassenen.

OBJECTIVE: To determine whether socio-economic differences in hospital admissions of adolescents and young adults are related to differences in intelligence. DESIGN: . Retrospective cohort study. METHODS: The data were derived from a group of 10,231 young adults and adolescents who were followed for a total of 47,212 person years with regard to their hospital admissions. Intelligence was measured in the first year of secondary school by 2 non-verbal intelligence tests for fluid intelligence. Data from hospital admissions were matched to a large-scale educational and occupational cohort. Data were analysed with Cox proportional hazards analysis. RESULTS: Intelligence was not found to be related to hospital admissions. However, a low occupational and educational level of the young adults or their parents, was strongly related to heightened risk for hospital admissions. In particular, the low socio-economic status of a respondent was associated with heightened risk for hospital admissions due to accidents (relative risk: 3.49; 95% confidence interval: 1.91-6.39). CONCLUSION: The small extent to which the socio-economic differences in hospital admissions seem to be based upon fluid intelligence, at least in adolescents and young adults, as well as the heightened risks of hospital admissions in lower socio-economic status groups and the associated high costs for health care legitimise further study of the determinants of these differences.

Management of rhinosinusitis in children.

The authors provide definitions for the different forms of pediatric rhinosinusitis, with an enumeration of the main symptoms and signs. They also provide the indications for CT scan examination and microbiological investigations. In addition, they emphasize the importance of concomitant systemic disease, such as allergy and immunological disorders. The adequate medical management, which is mandatory before any surgery, is considered and discussed, and the indications for surgery are provided.

Assessment of the quality of life of patients with advanced and end-stage cancer or serious infections with a symptom-based or an impact-based instrument.

In 1992 a project was started in which home care technology was made available to patients with cancer or serious infections. Primary care providers were trained and supported to administer parenteral drugs and fluids in the home setting. Between 1992 and 1995 we applied the Rotterdam Symptom Checklist (RSCL) and the Sickness Impact Profile (SIP) as questionnaires for quality of life (QoL) assessment in a group of 112 hospitalized patients who were prepared to receive further treatment at home. Scores on the RSCL revealed a high level of symptomatology in both the physical and the psychological dimension. Factor analysis showed a five-factor rather than a two-factor structure. The SIP showed considerable restrictions in daily living, particularly in the physical dimension. Whereas the RSCL and the SIP correlated well in the psychological and physical dimensions in advanced cancer patients, this correlation disappeared in the group of endstage cancer patients. The data indicate that the health-related QoL of end-stage cancer patients cannot be reliably be assessed with a symptom-based instrument alone; it needs to be supplemented by other instruments, such as the SIP.

Management of rhinosinusitis in children: consensus meeting, Brussels, Belgium, September 13, 1996.

OBJECTIVES: To (1) provide definitions for the different forms of pediatric rhinosinusitis, with an enumeration of the main symptoms and signs; (2) provide indications for microbiological, allergic, and immunologic assessment as well as for imaging studies; (3) suggest standard medical management with judicious use of antimicrobial agents; and (4) discuss indications for surgery. DATA SOURCES: Clinical studies and literature data relevant to the different topics of pediatric rhinosinusitis. CONCLUSIONS: Rhinosinusitis in children is a multifactorial disease in which the importance of several predisposing factors changes with increasing age. Continued study to obtain a better understanding of the disease and carefully controlled comparative evaluations of medical and surgical therapies are suggested.

The socio-economic distribution of heart diseases: changing gradients in The Netherlands.

Two different Dutch data-sets were used to examine trends in the association between socio-economic characteristics and the risk of heart disease. Data of the Dutch Quality of Life Surveys allowed the examination of trends in the association between educational level and self-reported heart disease during the period 1974-1993. For both the general Dutch population and the subpopulation of men aged 40 years and older, we found an inverse gradient during the whole period. The gradient climaxed at 1980-1983, and narrowed afterwards. Furthermore, ecological analyses, relating regional mean personal incomes to regional directly standardised mortality rates of coronary heart diseases (CHD) and all heart diseases, showed similar patterns of social differentials. The findings suggest that, in the Netherlands, there is a narrowing gradient of the association between socio-economic characteristics and heart disease in the late eighties and early nineties.

Conservative treatment of chronic maxillary sinusitis in children. Long-term follow-up.

A placebo-controlled prospective study is performed to evaluate conservative treatment of chronic maxillary sinusitis in children. Antibiotic treatment and drainage do not seem to have a permanent curative effect.

Transcultural differences in illness behaviour and clinical outcome: an underestimated aspect of general practice?

BACKGROUND: Our aim was to assess international differences in illness behaviour and clinical outcome for patients in Europe with an episode of acute tonsillitis. METHODS: The subjects were 2423 patients from seven countries whose acute tonsillitis was treated with antibiotics. Each country selected at least 10 GPs who filled in a questionnaire for each episode of acute tonsillitis treated during a 3-month period, November 1989-May 1990. The outcome measure was the number of days of illness. Backwards multiple regression analysis with predictors (age, sex, country, initial temperature, days prior to illness) was performed. RESULTS: The number of days of illness of patients with an episode of acute tonsillitis varied between the European countries, from 3 to 10 days. Country was the most important predictor, whereas disease-specific and patients' characteristics were not important predictors. CONCLUSIONS: Duration of illness was primarily influenced by country. The countries in Eastern Europe especially were characterized by a longer duration of illness. Transcultural differences may influence the duration of illness and need more attention in daily practice.

Double-blind randomised trial of co-amoxiclav versus placebo for persistent otitis media with effusion in general practice.

BACKGROUND: The treatment of persistent otitis media with effusion (OME) remains controversial, but this condition is the commonest reason for children to require ear, nose, and throat (ENT) surgery. Trials of antibiotics are inconclusive, are often weak methodologically, and have not been done in general practice. Our aim was a trial of an antibiotic for OME in such a population. METHODS: 433 children, aged 6 months to 6 years, with OME from 57 general practices entered a 3-month watchful waiting period. Of 223 (52%) with persistent bilateral OME, 162 were randomised double-blind to receive co-amoxiclav suspension (20 mg/kg amoxicillin, 5 mg/kg clavulanate potassium) or matching placebo, orally three times a day for 14 days. All cases also received xylometazoline 0.25% decongestant nosedrops thrice daily. Of the 61 not randomised, 13 children were referred to an ENT surgeon and parents refused consent in 48 cases. The main outcome measures were persistent OME in both ears and in one or both ears, as assessed clinically and by tympanometry. Analysis was by intention-to-treat. FINDINGS: 79 children in the treatment group and 70 in the placebo group were analysed for efficacy. 3 withdrew in the co-amoxiclav group (2 lost to follow-up, 1 due to side-effects); 6 withdrew in the placebo group (5 and 1, respectively). In addition, 4 tympanograms were uninterpretable in the controls. Compliance was over 90% in both groups. Persistent OME in both ears and in one or both ears were found at significantly lower rates in the co-amoxiclav group than in the controls at the 2-week follow-up: 53 vs 84% and 77 vs 93%, respectively. Odds ratios adjusted for sex, history of adenoidectomy, and upper respiratory tract infection at follow-up were 0.25 (95% CI 0.11, 0.58, p = 0.001) and 0.30 (0.10, 0.89, p = 0.03), respectively. Parents of children in the co-amoxiclav group reported significantly more side-effects than those of control children (44 vs 22%, p = 0.03). Side-effects were mostly gastrointestinal and mild. INTERPRETATION: Our study in a general-practice setting confirmed the positive short-term effect of antibiotic treatment for persistent middle-ear infection. Before referral to an ENT surgeon, children with persistent OME presenting to general practitioners could be considered for such treatment, depending on the individual child and possible adverse sequelae.

The evaluation of changes in functional health status in patients with abdominal complaints.

Measuring functional status changes in various patient subgroups is important in stratifying risk, assessing disease severity, and predicting and defining clinically relevant outcomes. Data from a multi-centered study of 980 primary care patients presenting with nonspecific abdominal complaints were studied to demonstrate the importance of such an assessment procedure. Patients were prospectively followed for 6 months. Five diagnostic categories based on illness duration and seriousness were derived from the clinical course of these patients. The functional status of each patient was determined at baseline, 1 month, and 6 months using the Sickness Impact Profile (SIP). Intraclass correlation coefficients accounted for two aspects of the reliability of the SIP regarding the measurement of change over time: differences between patients which are stable over time (reproducibility) and different effects of treatment between subsets (responsiveness). A priori formulated expectations about the degree of health status change in patient subgroups were evaluated with the help of effect-size calculations. Patient impairment only partially depended on the final diagnosis and was also influenced by the presence of co-morbidity, psycho-social determinants, and other complaints. The health status change in the patient subgroups agreed with a priori formulated expectations. Standardized effect-size calculations revealed that the degree of change over time in SIP scores was in accordance with these expectations. We conclude: (a) the SIP appeared to be a reliable clinimetric instrument in detecting change over time resulting from different clinical courses, (b) clinical studies that use clinimetric instruments to assess the effects of clinical interventions must adequately control for the influence of baseline "functional status" as well as traditional demographic features such as gender and age, and (c) evaluating a priori formulated clinical expectations concerning functional change with statistics such as intraclass correlation and effect sizes can lead to a clearer understanding of the clinical relevance of statistically significant changes.

[Quality of work and absenteeism: lower or higher in elderly workers?]. / Kwaliteit van de arbeid en ziekteverzuim: lager of hoger bij werkende ouderen?

Data of the Quality of Life Surveys 1990-1993 (n = 9969) were used to examine if and to what extent elderly workers differ from younger workers with regard to perceptions of the quality of work, especially the workload, and to the percentage absence due to sickness. Adjusted for occupational level, educational level and sex, persons aged 60-64 were characterised by either a substantially lower or a similarly perceived workload as compared to those aged 55-59. Subsequently, adjusted for the occupational level, educational level, sex and perceived workload, a substantial lower rate of absenteeism was found for persons aged 60-64. To a certain extent comparable results were found in the comparison of persons aged 55-59 with those aged 45-54. Based on the low grade of job participation of the elderly, it is proposed that these favourable figures support the notion of an age-related healthy-worker selection in the Netherlands.

Health-related quality of life in patients with osteoarthritis in a family practice setting.

OBJECTIVE: To study the impact of osteoarthritis (OA) on all areas of a patient's health-related quality of life. METHODS: The Sickness Impact Profile (SIP) was administered to a group of patients with OA selected from a family medicine setting. The results were compared to a reference population, stratified by age, and adjusted for sex. RESULTS: OA was associated with significant impairment, and had an important impact on, health-related quality of life in the areas of ambulation, body care and movement, emotional behavior, sleep and rest, home management, and work, especially in patients ages 41-60. The older patients differed less from the controls than did the younger ones. Items that contributed to the differences between OA patients and controls were mainly related to physical limitations. CONCLUSION: Most dysfunctions related to OA are physical.

How much ulcer is ulcer-like? Diagnostic determinants of peptic ulcer in open access gastroscopy.

A cross-sectional diagnostic prevalence study was carried out within a multi-centre experiment with open access gastroscopy in Utrecht, The Netherlands. The objective of the study was to contribute to improvement of patient selection for open access gastroscopy and to evaluate diagnostic determinants for peptic ulcer. Data were analysed in all 861 patients who were consecutively newly referred during the experiment to undergo gastrocopy. Patient characteristics and outcomes of gastroscopies were recorded. Univariate and multivariate (logistic) analyses were carried out and the results were evaluated with ROC (receiver operating characteristic) analysis. The most important clinical characteristics to be used for prediction of peptic ulcer are pain on an empty stomach, absence of pain after a meal and absence of obstructive complaints. The scoring list derived from the full model, comprising these characteristics together with age, sex, information on former dyspeptic diseases, medication and smoking ('basic characteristics'), predicted peptic ulcer with an AUC of 0.78. The 'ulcer-like' model, with characteristics known from the literature, had an AUC of 0.76. The amount of gastroscopy requests on patients suspected of a peptic ulcer could have been reduced from 60 to 44%. Forcing 'basic characteristics' into scoring lists on peptic ulcer improved the pre-diagnostic test capacities. The presented scoring list may improve gastroscopy requesting by GPs aiming at finding peptic ulcers. Practical manageability of the list should be prospectively evaluated in future experiments.

Simulated patients in assessing consultation skills of trainees in general practice vocational training: a validity study.

Although simulated patients are increasingly used in medical education, little research has been carried out on their validity. Validity in this case defines the relationship between performance with a simulated patient and performance with a real patient. One of the objectives of this study was to determine the validity of the use of simulated patients in assessing the consultation skills of trainees in vocational training at the Department of General Practice, University of Utrecht, The Netherlands. A check-list with a rating scale was used to assess the consultation skills of trainees at the department with simulated patients as well as in their training practices with real patients. The simulated and the selected practice cases were patients with complex multi-conditional problems like low back pain, headache and chest pain. The consultation skills were subdivided into four groups: the patient-centered approach, the non-somatic approach, communication skills and interpersonal skills. The measurement of skills, in particular of consultation skills, is very difficult. A description is given of the way the research group solved this problem. The analysis was performed by determining the sensitivity and predictive value of the assessment of a simulated encounter with a routine practice encounter. A difference existed in the assessed level of consultation skills in the simulated encounter compared to the level in the training practice. In simulation the level of consultation skills was higher than in day-to-day practice. This difference can reflect the difference between competence and performance. Competence is defined as what a doctor is capable of doing and performance as what a doctor actually does in day-to-day practice.(ABSTRACT TRUNCATED AT 250 WORDS)

Persistence of middle ear dysfunction after recurrent acute otitis media.

The presence of otitis media with effusion (OME) and high negative pressure (-200 to -400 mm H2O), were investigated in the follow-up of a randomized double-blind placebo-controlled trial on the efficacy of amoxicillin/clavulanic acid in the treatment of acute otitis media. All children in this study were recruited from a general practice population. Tympanometry results 1 month from the start of an episode of acute otitis media were taken as outcome criteria. Bilateral middle ear dysfunction was defined as bilateral OME, unilateral OME and contralateral or bilateral high negative pressure. Bilateral middle ear dysfunction was present in 47.9% of the patients. Of all the investigated factors of possible influence (age, sex, season, laterality of acute otitis media, therapy, and clinical course of acute otitis media), only season showed a statistically significant influence on the persistence of OME/high negative pressure (P = 0.001). Bilateral middle ear dysfunction was shown to be of prognostic value for the risk of a recurrence of acute otitis media (odds ratio 3.75).

Bacterial flora in patients presenting with sore throat in Dutch general practice.

The bacterial growth in patients presenting with a sore throat was assayed and four clinical features were tested in order to reliably differentiate between beta-haemolytic streptococci group A (GABHS) and other micro-organisms. For 2 years, 53 general practitioners (GPs) in The Netherlands took throat swabs from all patients, aged 4-60, presenting with a sore throat lasting 14 days or less. Four clinical features: fever (history), (tonsillary) exudate, anterior cervical lymphadenopathy and absence of cough were registered. In 70% of the 598 patients one or more micro-organisms were cultured from throat specimens. In 48% of the patients beta-haemolytic streptococci were found (32% group A, 7% group C, 4% group G, 5% others). Enterobacteriaceae were cultured in 5%, Candida albicans in 5%, Staphylococcus aureus in 4%, various others in 8% of the patients. In 30% of the patients cultures remained negative. Of the 270 patients with three or four clinical features, 46% (95% Cl, 40-52%) harboured GABHS in their throats, while in 328 patients with less than three features 21% (95% Cl, 16-25%) were GABHS positive. However, this relationship between presence or absence of clinical features and culture result was not found in the youngest age category (4-14 years old). Culture results were not related to sex, smoking habits or the insurance mode of the patient. The clinical relevance of several micro-organisms, other than beta-haemolytic streptococci, remains to be determined. The four mentioned signs and symptoms were helpful in predicting the probability of GABHS in patients aged 15 years and older.(ABSTRACT TRUNCATED AT 250 WORDS)