A smoking prevention project in six European countries (European Smoking prevention Framework Approach) was developed, featuring activities for adolescents, schools and parents, including out-of-school activities. Consensus meetings resulted in agreement between the countries on goals, objectives and theoretical methods. Countries' specific objectives were also included. National diversities required country-specific methods to realize the goals and objectives. The community intervention trial was used as the research design. Since interventions took place at the community level, communities or regions were allocated at random to the experimental or control conditions. Complete randomization was achieved in four countries. At baseline, smoking prevalence among 23 125 adolescents at the start of the project was 5.6% for regular smoking and 4.0% for daily smoking. Smoking prevalence rates were higher among girls than boys in all countries as far as weekly smoking was concerned. Process evaluations revealed that the project's ambitions were high, but were limited by various constraints including time and delays in receiving funds. Future smoking prevention projects should aim to identify the effective components within the social influence approach as well as within broader approaches and on reaching sustained effects.

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We conducted a prospective study to update our knowledge of fever of unknown origin (FUO) and to explore the utility of a structured diagnostic protocol. From December 2003 to July 2005, 73 patients with FUO were recruited from 1 university hospital (n = 40) and 5 community hospitals (n = 33) in the same region in The Netherlands. FUO was defined as a febrile illness of >3 weeks' duration, a temperature of >38.3 degrees C on several occasions, without a diagnosis after standardized history-taking, physical examination, and certain obligatory investigations. Immunocompromised patients were excluded. A structured diagnostic protocol was used. Patients from the university hospital were characterized by more secondary referrals and a higher percentage of periodic fever than those referred to community hospitals. Infection was the cause in 16%, a neoplasm in 7%, noninfectious inflammatory diseases in 22%, miscellaneous causes in 4%, and in 51%, the cause of fever was not found (no differences between university and community hospitals). There were no differences regarding the number and type of investigations between university and community hospitals. Significant predictors for reaching a diagnosis included continuous fever; fever present for <180 days; elevated erythrocyte sedimentation rate, C-reactive protein, or lactate dehydrogenase; leukopenia; thrombocytosis; abnormal chest computed tomography (CT); and abnormal F-fluorodeoxyglucose positron emission tomography (FDG-PET). For future FUO studies, inclusion of outpatients and the use of a set of obligated investigations instead of a time-related criterion are recommended. Except for tests from the obligatory part of our protocol and cryoglobulins in an early stage, followed by FDG-PET, and in a later stage by abdominal and chest CT, temporal artery biopsy in patients aged 55 years or older, and possibly bone marrow biopsy, other tests should not be used as screening investigations.

This study assessed the relationship between the smoking behavior of adolescents and the smoking status of their parents and friends among adolescents from six European countries. A longitudinal study collected data from 15 705 adolescents on their own smoking status, and that of their parents, best friend and friends in general. Cross-sectional regression analysis showed that adolescent smoking was most strongly associated with friends' smoking and best friend's smoking, explaining 38% of the variance in the total sample. Longitudinal regression analysis, however, showed that the beta coefficients of the smoking status of the best friend and friends in general were comparable to that of parental smoking. Parental smoking behavior was found to be as predictive of smoking onset after 1 year as friends' smoking status.

Cross-sectional studies integrating motivational stages with expectancy value models have suggested that contemplating smokers pcrceive more advantages of quitting and social support than precontemplators. Moreover, smokers preparing to quit were found to differ h m precontemplators and contemplators by having higher selfefficacy expectations.Using the ASE model, the present study confirmed the findings of these cross-sectional studies. The longitudinal design of this study, however, facilitated prediction of transitions that smokers made during a 10-month follow-up. Smokers who progressed from precontemplation perceived more advantages of quitting than those who remained in precontemplation. Smokers regressed from contemplation perceived fewer advantages of quitting than those who did not regress. Finally, smokers who progressed from preparation had higher self-efficacy expectations than those who did not progress.In sum, the present study provided longitudinal support for the #-pattern, which suggests tailoring of health educational messages to subjects in the various stages of change.

Inhaled medication is commonly prescribed for the treatment of asthma and chronic obstructive pulmonary disease (COPD), but is often not properly used by patients. A total of 316 patients suffering from asthma or COPD took part in a study that evaluated how patients utilized their metered-dose inhaler (MDI) or dry powder inhaler, using a standardized inhaler checklist. Two hundred eighty-one patients (88.9%) made at least one mistake in the inhalation technique. The mistakes were classified into skill and nonskill mistakes. Two hundred patients made one or more skill mistakes and 81 patients only made one or more nonskill mistakes. The most common skill error was "not continuing to inhale slowly after activation of the canister" (69.6%). The nonskill item most patients had difficulties with was "exhale before the inhalation" (65.8%). Patients who used an MDI made significantly fewer nonskill mistakes than patients using a dry powder device. Older patients had more difficulty with the correct use of the inhaler than younger patients. There was no difference in errors between men and women. In this patient sample, most patients failed to use their inhaler correctly. Regular instructions and checkups of inhalation technique are the responsibility of the physician and should be a standard and routine procedure.

Background: Limited data are available on the development, implementation and evaluation processes of physical activity promotion programmes among older adults. More integrative insights into interventions describing the planned systematic development, implementation and evaluation are needed.

Continuous glucose monitoring systems for type 1 diabetes mellitus.