The European Innovation Partnership on Active and Healthy Ageing Synergies: Protocol for a Prospective Observational Study to Measure the Impact of a Community-Based Program on Prevention and Mitigation of Frailty (ICP - PMF) in Community-Dwelling Older Adults.

Aim of this paper is to describe the protocol of the study "Impact of a Community-based Program on Prevention and Mitigation of Frailty in community-dwelling older adults" developed in the framework of the European Innovation Partnership on Active and Healthy Ageing. This proposal has been developed by the Partnership Action groups on frailty, fall prevention and polypharmacy in older. The proposal wants to assess the impact of community-based programs aimed to counteract three main outcomes related to frailty: hospitalization, institutionalization and death. Bringing together researchers from seven European countries, the proposal aims to achieve the critical mass and the geographical extension enough to provide information useful to all older European citizens. An observational study will be carried out to calculate the incidence of the different outcomes in relation to the various interventions that will be assessed; results will be compared with data coming from already established national, regional and local dataset using the observed/expected approach. The sample will be made up by at least 2000 citizens for each outcome. All the citizens will be assessed at the baseline with two multidimensional questionnaires: the RISC questionnaire and the Short Functional Geriatric Evaluation questionnaire. The outcomes will be assessed every six-twelve months.

Wheezing in early life and asthma at school age: predictors of symptom persistence.

Early childhood wheezing is associated with asthma later in life. However, the high spontaneous recovery rate and the lack of firm predictors for persistence of wheezing complicates the development of evidence-based guidelines for long-term management of wheezy infants and toddlers. Our aim was to define variables that could be used to identify wheezy individuals younger than 3 years of age who would continue to be symptomatic at school age. The method used was a questionnaire-based cross-sectional survey of 2,027 randomly chosen, 6-13-year-old school children. Altogether 1,829 (90%) questionnaires were returned. Emergency medical care had been sought for 186 (10.2%) children for wheezing during the first 3 years of life, and only 17.2% of these children had received similar emergency treatment during the 12 months preceding the survey. The total proportion of children with current asthma at school age was 11.4%. A logistic regression analysis indicated that for the early wheezers, a family history of asthma, an itchy rash or food allergy, and exposure to tobacco smoke at home before the age of 3 years, were all independently associated with symptom persistence until school age. Among all wheezy children younger than 3 years, those who have a history of food allergy, itchy rash, asthma occurrence in a sibling or parent, or are exposed to tobacco smoke during the first years of life are at highest risk for symptom persistence until school age.

Regional variation in the diagnosis of asthma among preschool-age children.

To study potential regional variation in asthma diagnostics, we retrospectively analyzed the management of 800 acutely wheezing preschool-age children in two university clinics in Finland. Multivariate modelling indicated that the place of treatment was a strong independent predictor of asthma diagnosis during acute symptoms. Similar regional preferences in diagnostic activity may exist in other countries.

Corticosteroid therapy and need for hospital care in wheezing preschool children.

OBJECTIVES: To study the frequency of corticosteroid therapy and the use of inpatient care for preschool children with wheezing in two regions in Finland. METHODS: The Finnish Social Insurance Institution database on refundable asthma medication indicated that 1.18% of children in Tampere and 2.37% in Turku used inhaled corticosteroids regularly. To clarify the difference, hospital records of 800 randomly chosen 0.5-6.9-year-old children who had been treated for wheezing in Tampere or Turku University Hospital during 1995-1996 were retrospectively analysed. RESULTS: The incidences of wheezing-related emergency room (ER) index visits were 11.0 visits/year/1000 children both in Tampere and Turku. Oral corticosteroids were given to 2.5% versus 24.2% of children in ER and 10.6% versus 89.7% in hospital ward in Tampere and Turku, respectively. Hospitalisation rates were 44.8% in Tampere and 36.8% in Turku (95% confidence interval for the difference 1.2-14.8%). In both regions, children with prior inhaled corticosteroid therapy needed less inpatient care. Mean duration of hospitalisation was 3.4 days in Tampere and only 1.4 days in Turku. Recurrent visits in 6 months were more common in Tampere. CONCLUSIONS: There were marked regional differences in the management of preschool children with wheezing. On a population level, frequent use of corticosteroid therapy was associated with reduced hospital admissions.

Static-wavelength independent radiation attenuator.

The static radiation attenuator consists of one or several layers of absorbing material into which randomly distributed holes are drilled. The attenuator needs no moving parts and reduces not only the time averaged but also the instantaneous brightness, and reduction by an arbitrarily large factor can be easily achieved. The transmitted intensity fluctuates randomly as a function of spatial position, but the expected fluctuation can be evaluated and can be made arbitrarily small. Various properties of the device are explored.