The future of primary paediatric care in Europe: reflections and Report of the EPA/UNEPSA Committee

Background:  Changes in the scope of the field of paediatrics and the variability in primary paediatric care (PPC) and practice throughout Europe motivated the European Paediatric Association and Union of National European Paediatric Societies and Associations (EPA/UNEPSA) to establish a working group to discuss definitions of paediatric coverage in terms of age limits, find common denominators in the provision of PPC and examine the challenges and goals of 21st century paediatrics relevant to the continent. These issues were presented at the 2008 Europaediatrics in Istanbul, where a consensus declaration was drawn up and accepted by the EPA/UNEPSA Executive Committee.
Aim:  To present an outline of the essential elements of the 2008 EPA/UNEPSA Executive Committee consensus declaration.
Conclusion:  The definition of basic characteristics and the establishment of requirements for optimal PPC and practice are important steps in overcoming the differences among European countries and pave the way for an acceptable formulation of standardized high-quality paediatric medical care in Europe.     

Clinical diagnosis of acute bacterial rhinosinusitis, typical of experts

Background  Clinical diagnosis of acute bacterial sinusitis (ABS) is a concern when a patient presents with nasal discharge of recent onset together with facial pain or pressure. Given this presentation, the doctor would benefit from having access to software that specifies, first, what diagnostic indicators experts typically use in that diagnosis and then, upon entry of those facts, what experts' typical probability of ABS is in such a case.
Methods  We specified a set of 23 hypothetical presentations of this type by patients 20–75 years of age, involving a comprehensive set of clinical-diagnostic indicators. Members of an international expert panel independently set the probability of ABS in each of these cases. A logistic function of the diagnostic indicators was fitted to the medians of the probabilities.
Results  The fitting led to an expression of the experts' median probability of ABS as a joint function of the duration of the patient's facial pain/pressure, and indicators of the location(s) of this; indicators of exacerbation of the pain/pressure on bending forward, nasal obstruction, maxillary and/or frontal tenderness, pus from middle meatus, purulent postnasal drip, and fever; and indicators of recent upper respiratory tract infection, nasal polyposis and status post sinus surgery. This probability function is accessible at http://www.evimed.ch/ABS .
Interpretation  That probability function, made readily accessible, provides for expertly probability setting in clinical diagnosis of ABS, relevant for decisions about further diagnostics or treatment without further tests.     

Inflammation and Fat Mass as Determinants of Changes in Physical Capacity and Mobility in Older Adults Displaying A Large Variability in Body Composition: The NuAge Study

Background/Study context: Determining whether C-reactive protein (CRP), blood lipids, total and trunk fat mass (FM), and waist circumference (WC) are associated with changes in physical capacity over 3 years (Δ) in elderly.

Methods: One hundred twenty-two men and women 68–83 years of age participated in a 3-year follow-up study. Physical capacity was measured using five objective tests: (1) Timed Up and Go (TUG), (2) chair stand (CS), (3) normal walking speed (NWS), (4) fast walking speed (FWS), and (5) one-leg stand (LS), along with physical performance score (PPS) at baseline (T1) and 3 years later (T4). Total and trunk FM, WC, blood lipids, and CRP measured at baseline, were considered as potential predictors.

Results: At baseline, CRP and total FM were significantly correlated with all physical capacity tests, whereas trunk FM was correlated with CS and LS, and blood lipids only with FSW. No significant correlation was observed for WC. Total and trunk FM measured at baseline were correlated with ΔTUG and ΔPPS, whereas trunk FM and WC measured at baseline were correlated with ΔNWS. CRP and blood lipids, measured at baseline, were not associated with any changes over 3 years. At the end, WC measured at baseline was the strongest independent predictor for all physical capacity measures at baseline (T1), and ΔPPS measured over 3 years could be predicted by baseline WC.

Conclusion: FM distribution seems more useful to determine physical capacity than inflammation. Interestingly, over a short follow-up of 3 years, WC significantly predicted changes in a composite score of physical activity. More studies are needed to elucidate factors that may influence physical capacity decline over time.