WHAT'S KNOWN ON THIS SUBJECT: Health care professionals face problems managing obesity and often fail to follow guidelines for its management in practice. Only a few singlecountry reports are available describing delivery of primary care to children with obesity. WHAT THIS STUDY ADDS:Nearly all primary pediatric care providers from 4 European countries recognize the importance of obesity in pediatric practice, but only half use BMI clinically, and many lack the confidence and the infrastructure needed for providing care to patients with obesity. abstract OBJECTIVE: To determine and compare attitudes, skills, and practices in childhood obesity management in 4 European countries with different obesity prevalence, health care systems, and economic situations. METHODS:A cross-sectional survey was distributed to primary health care providers from France, Italy, Poland, and Ukraine. The questionnaire was returned by 1119 participants with a response rate of 32.4%. RESULTS:The study revealed that most of the primary health care providers were convinced of their critical role in obesity management but did not feel sufficiently competent to perform effectively. The adherence to recommended practices such as routine weight and height measurements, BMI calculation, and plotting growth parameters on recommended growth charts was poor. Most primary health care providers recognized the need for continuing professional education in obesity management, stressing the importance of appropriate dietary counseling. CONCLUSIONS:The study underlines insufficient implementation of national guidelines for management of obesity regardless of the country and its health system. It also makes clear that the critical problem is not elaboration of guidelines but rather creating support systems for implementation of the medical standards among the primary care practitioners. Pediatrics 2013;132:e100-e108 AUTHORS:

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The primary and proven therapy, in cases of celiac disease (CD), is a rigorous gluten-free diet (GFD). However, there are reports of its negative effects in the form of nutritional deficiencies, obesity, and adverse changes in body composition. The study aimed to assess the impact of a GFD on the body composition of children with CD. In a case-controlled study (n = 41; mean age 10.81 y; SD = 3.96) children with CD, in various stages of treatment, underwent medical assessment. The control group consisted of healthy children and adolescents, strictly matched for gender and age in a 1:1 case-control manner. More than half of the examined children (n = 26) followed a GFD. CD children had significantly higher mean values of the fat free mass (FFM% = 80.68 vs. 76.66, p = 0.015), and total body water (TBW% = 65.22 vs. 60.47, p = 0.012), and lower mean values of the fat mass (FM% = 19.32 vs. 23.34, p = 0.015). Children who were on a GFD presented slightly higher, but not statistically significant, mean values of FM and FFM, than children who did not follow dietary recommendations (FM [kg] = 7.48 vs. 5.24, p = 0.064; FM% = 20.81 vs. 16.73, p = 0.087; FFM [kg] = 28.19 vs. 22.62, p = 0.110). After minimum one year of a GFD, CD children showed significantly higher values of FFM [kg] (p = 0.001), muscle mass (MM) [kg] (p < 0.001), TBW [L] (p < 0.001) and body cell mass (BCM) [kg] (p < 0.001). Furthermore, CD children who were on a GFD presented a significantly higher increase in weight (p = 0.034) and body mass index (BMI) (p = 0.021). The children adhering to a GFD demonstrate a tendency towards higher indices of selected body composition components.

Background. Health-related behaviours and lifestyle are related to the salutogenic concept of health, whereas the major public health problems faced in rural areas include difficulties in encouraging people to a healthy lifestyle. Objective. The aim of the study is to explore mutual relationships between psychosocial-demographic factors and a sense of coherence. Material and method. Two-stage sampling was applied. Data were collected with the use of the Juczynski Health Behaviours Inventory and Antonovsky's SOC-29 (Sense of Coherence Questionnaire). The study was conducted among 668 adults. Data were statistically prepared using one-way ANOVA test, linear correlation analysis, and linear regression model. Results. A higher level of pro-health behaviours is associated with gender, self-rated health, sense of coherence and age. Almost half of the farmers were characterized by a low level of pro-health attitudes. A higher level of pro-health behaviours was demonstrated by less than one-fifth of the farmers. Conclusions. There is a strong association between sense of coherence and pro-health behaviours. Farmers have bad habits and pro-health attitudes to health and poorer self-assessment of their health. There is a great need to monitor health-related behaviour, increase the effectiveness of health promotion and health education in shaping a pro-health lifestyle among residents of rural areas, particularly among farmers.

Nurses and physician need to become aware of the counterfeit medicines phenomenon. Nurses are well positioned to assume the active role in educating patients about the threat of the presence of counterfeit medicines so as to enhance safety for their patients. However, to accomplish that aim, these findings suggest that healthcare professionals need to become better educated about counterfeit medicines and need to be trained in skills to identify counterfeit medicines.