[Favorable effects of a stay in the Dutch Asthma Center Davos on medical consumption and quality of life in COPD patients]. / Gunstige effecten van een verblijf in het Nederlands Astmacentrum Davos op medische consumptie en kwaliteit van leven bij CARA-patiënten.

The Dutch Asthma Centre Davos in Switzerland is a clinic where patients with chronic nonspecific lung disease (CNSLD) are given multidisciplinary treatment. In a prospective study in the clinic, data on quality of life (functional, psychological and social characteristics) and medical consumption (use of oral corticosteroids and use of health services) were collected in a group of 147 patients with CNSLD. 18 patients were lost due to non-medical reasons. Quality of life and the use of oral corticosteroids were registered on admission, at discharge and 4 weeks, 6 and 12 months after discharge. Data on use of health services were gathered over the period between one year before admission and one year after discharge from the asthma centre. The results of this study show a decrease in the use of oral corticosteroids, in the number of visits to the family physician and outpatient department and the number and duration of hospital admissions. Favourable changes occurred in psychological functioning, (including anxiety and depression) and positive changes were observed in the degree of limitation the patients experienced in their activities of daily living. No convincing changes were found in social functioning, including social support. It can be concluded, on the basis of these results, that a stay in the Dutch Asthma Centre Davos has favourable effects on medical consumption and on some aspects of quality of life.

Pulmonary rehabilitation in an asthma clinic.

For a small proportion of patients with respiratory disorders, the regular medical care provided by general practitioners and chest physicians does not result in control of respiratory symptoms. In the Dutch Asthma Center, Davos, Switzerland, two conditions not available in routine medical settings are instrumental in treating patients with severe respiratory illness. The treatment center is located at 1560 m above sea level in a high altitude climate (low air humidity, low allergen concentration) which helps stabilize respiratory symptoms. Second, an interdisciplinary treatment plan encompasses optimal medical care and psychological interventions (patient education, self-management training). In this treatment facility, we carry out a cohort study on the determinants of the course of respiratory disorders in the adult patients. At admission, at discharge, and at 6-month follow-up, patient are assessed on medical, psychological, and medical outcome variables. At 6-month follow-up, 35% of the patients were readmitted to a hospital for exacerbations of respiratory symptoms. Multivariate analyses point out that both pulmonary function and psychological factors (particularly state anxiety and agoraphobia) predicted admission. Additional data will be presented and the implications for the multidisciplinary treatment will be discussed.

Quieting during early infancy: evidence for a developmental change?

The ability to terminate crying (quieting) without intervention was studied from 0 to 18 weeks. Two groups were involved: 11 newborns during the first hour after birth and a longitudinal group of 14 infants seen every 3 weeks from 3 to 18 weeks. Most newborns who cried showed quieting with and without hand-mouth contacting. In the longitudinal group quieting with hand-mouth contacting appeared for the first time at 9 weeks (quieting without hand-mouth contacting being present from 3 weeks). Quieting with hand-mouth contacting was frequently accompanied by hand chewing/sucking. Explanations for the disappearance in quieting with hand-mouth contacting and its reappearance at 9 weeks concern changes in movement and posture. Explanations based on notions of intentionality in quieting were not supported by the data.