1,721,029 research outputs found
Conceptual Design of Future Children's Hospitals in Europe: Planning, Building, Merging, and Closing Hospitals.
No full textDesigning children’s hospitals requires new solutions for
the re-organization of services, and renovating,
merging, or closing old hospitals, as well as building
new children’s hospitals. This article is the first of a 3-report
series opening the debate on the future of children’s hospitals
in Europe. Children’s hospitals should be child friendly and safe, thus creating
a “small world in itself.” They must communicate with
the outside world and offer a comprehensive expertise to the
regional territory. Large children’s hospital should provide specialist
tertiary and quaternary services for children, including
highly specialized equipment and access to rare procedures
and clinical trials that may involve experimental treatments and
procedures. Furthermore, each specialist unit should provide
outreach clinics in regional centers, bringing their expertise
closer to the patient, and also should be able to engage in shared
care arrangements with local pediatricians working in regional
pediatric units. It is conceivable that such hospital model,
proposing high quality standards of safe and reliable care for
all children, would become progressively the preferred alternative
to standalone children’s hospitals and mother and child
centers. These centers may become less relevant to the population
and therefore less likely to maintain any political support
that may have favored their survival throughout the years,
despite a likely substantial inefficienc
Views of the Presidents of National European Pediatric Societies on Evolving Challenges of Child Health Care
No full textThe article discusses the evoilving challenges of child care in Europe. The poor organization of first-access care for children for nights and weekends was found to be the Achilles heel of primary care, leading to an increased risk of inadequate care by physicians with a lack of training in pediatrics. Second, inadequate referral of young patients to outpatient clinics in children’s hospitals was emphasized to be an important vulnerable element of child care, which may lead to unnecessary admissions of patients and further workload for hospital teams. In addition, most European countries reported to lack well-established pathways for a child with common conditions such as earache during outof-working hours. Thus, it was further emphasized that classic questions like “who, where, when, how, why” would need to be resolved in all those areas—especially rural ones—where an adequate service is not offered during nights and weekends
Integrating and rationalizing public healthcare services as a source of cost containment in times of economic crises
Full text linkBackground: Serious concern has been raised about the sustainability of public health care systems of European Nations and ultimately about the health of European citizens, as a result of the economic crisis that has distressed Europe since 2008. The severe economic crisis of the Euro zone, which is still afflicting Europe in 2016, has in fact threatened to equally impact public health services of nations presenting either a weak or a strong domestic growth.
Comments: On behalf of the European Paediatric Association, the Union of National European Societies and
Associations, the authors of the Commentary debates the relationship between the effects of economic instability
and health, through the report on an article recently published in the Italian Journal of Pediatrics, which
emphasized the importance of integrating existing public health care services, otherwise independently provided
by public hospitals, and Primary Care Paediatric networks. The interconnections between the effects of economic instability and health are briefly commented, following the observation that these two factors are not yet fully understood, and that the definition of proper solutions to be applied in circumstances, where health is negatively impacted by periods of economic distress, is still open for discussion. Furthermore it is noted that the pressure to “deliver more for less” often seems to be the driving force forging the political strategic decisions in the area of pediatric healthcare, rather than social, cultural, and economic sensitivity and competences. Thus, the delivery of appropriate pediatric healthcare seems not to be related exclusively to motivations aimed to the benefit of children, but more often to other intervening factors, including economic, and political rationales.
Conclusions: The conclusions emphasize that local European experiences suggest that positive and cost effective healthcare programs are possible, and they could serve as a model in the development of effective cross-border regional program, not weakening the quality of services provided to children
Opening the Debate on Pediatric Subspecialties and Specialist Centers: Opportunities for Better Care or Risks of Care Fragmentation?
Full text linkExpert specialist care is essential for the diagnosis of rare conditions and for children who require complex investigations and highly technical interventions, such as transplantation. This intensive specialist care often requires deep collaboration between a number of specialists to ensure optimal outcomes. Generally, how this specialist care is planned, organized, funded, and assured has not been fully researched, thus, the result is a huge diversity of provision across Europe.
Less well-resourced countries in Eastern Europe face the dilemma of how best to develop specialist care in the future, better resourced countries in Western Europe face the problem
of how best to rationalize and co-locate interdependent specialist services to improve outcomes, and small countries must find ways of developing effective cross-border care.
Large centers with multiple specialists often are recommended as the best way forward, but this strategy also risks fragmentation and potentially undermines the competence within local hospitals, as well as being inconvenient for families living far away. The Article describes the nature of specialist care, the training of specialists, and the interdependencies between specialist teams and propose networked solutions to overcome some of the concerns, such as the increasing gap between primary and tertiary care
Introduction to “Diversity of Child Health Care in Europe: A Study of the European Paediatric Association/Union of National European Paediatric Societies and Associations”
No full textThe field of pediatrics in Europe is characterized by the diversities, variations, and heterogeneities of child health care services provided in 53 European countries with more than 200 million children below 18 years of age. Managing the health care of infants, children, and adolescents in Europe requires balancing clinical aims, research findings, and socioeconomic goals within a typical environment characterized by cultural and economic complexity and large disparity in availability, affordability, and accessibility of pediatric care. Since its foundation in 1976, the European Paediatric Association-Union of National European Paediatric Societies and Associations has worked to improve both medical care of all children and cooperation of their caretakers in Europe. Such a report has been conceived in the strong belief that broadening of the intellectual basis of the European Paediatric Association- Union of National European Paediatric Societies and Associations and creating a multidisciplinary society will be necessary to reduce fragmentation of pediatrics and tackle the legal, economic, and organizational challenges of child health care in Europe
Diversity of Pediatric Workforce and Education in 2012 in Europe: A Need for Unifying Concepts or Accepting Enjoyable Differences?
Full text linkObjectiveTo evaluate differences in child health care service delivery in Europe based on comparisons across health care systems active in European nations.Study designA survey involved experts in child health care of 40 national pediatric societies belonging both to European Union and non-European Union member countries. The study investigated which type of health care provider cared for children in 3 different age groups and the pediatric training and education of this workforce.ResultsIn 24 of 36 countries 70%-100% of children (0-5 years) were cared for by primary care pediatricians. In 12 of 36 of countries, general practitioners (GPs) provided health care to more than 60% of young children. The median percentage of children receiving primary health care by pediatricians was 80% in age group 0-5 years, 50% in age group 6-11, and 25% in children >11 years of age. Postgraduate training in pediatrics ranged from 2 to 6 years. A special primary pediatric care track during general training was offered in 52% of the countries. One-quarter (9/40) of the countries reported a steady state of the numbers of pediatricians, and in one-quarter (11/40) the number of pediatricians was increasing; one-half (20/40) of the countries reported a decreasing number of pediatricians, mostly in those where public health was changing from pediatric to GP systems for primary care.ConclusionsAn assessment on the variations in workforce and pediatric training systems is needed in all European nations, using the best possible evidence to determine the ideal skill mix between pediatricians and GPs
Vaccine Hesitancy and Refusal
Full text linkver the past few years, an increasing number of European pediatricians, particularly primary care pediatricians, are facing the growing threat of vaccine hesitancy and refusal, a sort of a “cultural epidemic,” which seems to progressively affect the families of children under their care. In several communities, a growing number of individuals
are delaying or refusing available recommended and/or mandatory vaccinations for themselves and their children.
Furthermore, vaccination is increasingly perceived as unsafe and unnecessary by a rising number of parents, although it has been widely proven and recognized to be one of the greatest, safest, and most successful public healthmeasures ever adopted.The aim of the article is to describe vaccine hesitancy and refusal in an effort to further raise the awareness of pediatricians on this potential threat for their communities, and, in particular, for children under their care.
Definition and Effects of
Diversity and differences of postgraduate training in general and subspecialty pediatrics in the European Union.
Full text linkThe profound diversities among the EU28 postgraduate
pediatric programs have been analyzed in this study. In general they are attributable to a multiplicity of factors, which are descrtibed in the paper. The original data included in the article show how the postgraduate pediatric training is currently (2014) performed in the EU28 nations. The 28 different national programs last
from 4 to 8 years and present strikingly diversities. We
have arbitrarily divided the nations into two groups: Group
A includes nations that offer a 4-year basic course in general
pediatrics and in some cases an additional 1-3 years optional
training in selected pediatric subspecialties, and Group B includes nations that offer a 5- to 8-year basic course in pediatrics, including general pediatrics and part of pediatric
subspecialties, which in some cases may be further expanded
by 1-3 years of specific subspecialty training. The educational
system in the Group B nations is intended to ensure that primary care pediatricians are prepared for the diversity of clinical and social problems that they will encounter and that
specialist pediatricians receive sufficient training in rare
and complex disorders. In conclusion, the evidence of a profound diversity of postgraduate pediatric training programs among the EU28 should be carefully considered and addressed, as a propaedeutic approach to ensure the appropriateness and feasibility of any QA and QI assessment program and ultimately to ensure a satisfactory and appropriate level of pediatric health care for European children in future decades
Participation of Children and Young People in Their Health Care: Understanding the Potential and Limitations
No full textThe article focuses on the participation of children in pediatric care, which means that the child’s voice must be heard and opinion respected. It is the responsibility of duty-bearers (eg, physicians, nurses, parents) to ensure the rights of rights-holders (children) are fulfilled. Participation is based on a positive mental attitude of all people involved, and should improve all aspects of health care delivery. If successful, it should generate a new culture of authentic partnership between all involved—including children and adolescents—whose views are required to improve hospital structure and function,
as well as processes of medical care, systems development, the generation of health policy, medical education, and research. Participation of children and adolescents in pediatrics also includes developing new strategies for preventing illnesses by addressing risk-taking behaviors and positive health determinants, not only in vulnerable populations but by understanding and addressing the existential vulnerability of all young people. Developing these concepts together with young people to: (1) improve quality of health care; (2) design pathways for translating evidence into practice; and (3) monitor and evaluate patient safety will require focused participatory activities
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