Child Health Systems in Sweden.

On a national level, several factors are responsible for Sweden's leading position in achieving the excellent health of children because Sweden has experienced a long history of peace and success in establishing a parliamentary democracy throughout the 20th century. Among the different sectors of society, Sweden has been able to focus on prevention and health promotion. The Swedish health care system is publicly financed based on local taxation. Pediatricians working in secondary and tertiary care are employed by the public sector, whereas family physicians are employed by both the private and public sectors. The pediatric departments at county and university levels provide a high quality of inpatient care for neonates and children. The county hospital pediatric departments typically include one neonatal ward and one ward for older children. Subspecialization exists even at the county level, and there is close cooperation between the county level and subspecialist units at the university level. Within the primary care sector, most children receive care from family physicians. The majority of family physicians have completed 3 months of pediatrics in their basic training program. In the more densely populated areas there are also pediatric ambulatory care centers working mostly with referrals from the family physicians. Preventive care is carried out at midwife-led maternity health centers, nurse-led Child Health Centers, and nurse-led school health care settings and reach almost everyone (99%). All health care for children and adolescents is free of charge up to 18 years of age.

Human papillomavirus vaccination crisis in Japan.

The European Academy of Paediatrics (EAP) is gravely concerned about the human papillomavirus (HPV) vaccination crisis in Japan and particularly about the negative position taken by governmental authorities. Given that the HPV vaccine is both safe and effective, there is no recognizable reason to date to withhold this lifesaving and cost effective public health measure from a population. Therefore, the EAP strongly encourages the Japanese health authorities to actively support HPV vaccination for the future health of their children and adolescents.

Paediatric primary care in Europe: variation between countries.

BACKGROUND: Although it is known that differences in paediatric primary care (PPC) are found throughout Europe, little information exists as to where, how and who delivers this care. The aim of this study was to collect information on the current existing situation of PPC in Europe. METHODS: A survey, in the form of a questionnaire, was distributed to the primary or secondary care delegates of 31 European countries asking for information concerning their primary paediatric care system, demographic data, professionals involved in primary care and details of their training. All of them were active paediatricians with a broad knowledge on how PPC is organised in their countries. RESULTS: Responses were received from 29 countries. Twelve countries (41%) have a family doctor/general practitioner (GP/FD) system, seven (24%) a paediatrician-based system and 10 (35%) a combined system. The total number of paediatricians in the 29 countries is 82 078 with 33 195 (40.4%) working in primary care. In only 15 countries (51.7%), paediatric age at the primary care level is defined as 0-18 years. Training in paediatrics is 5 years or more in 20 of the 29 countries. In nine countries, training is less than 5 years. The median training time of GPs/FDs in paediatrics is 4 months (IQR 3-6), with some countries having no formal paediatric training at all. The care of adolescents and involvement in school health programmes is undertaken by different health professionals (school doctors, GPs/FDs, nurses and paediatricians) depending on the country. CONCLUSIONS: Systems and organisations of PPC in Europe are heterogeneous. The same is true for paediatric training, school healthcare involvement and adolescent care. More research is needed to study specific healthcare indicators in order to evaluate the efficacy of different systems of PPC.

Chlamydia pneumoniae infection predicts a reduced risk for subsequent atopic disease.

AIM: To investigate long-term effects on children previously infected with Chlamydia pneumoniae. METHODS: A follow-up questionnaire was sent to all participants from a former population-based study in order to investigate health status during the 4 y that had elapsed between the two studies. In the original study, the prevalence of C. pneumoniae infection was 23% as determined by PCR analyses on throat swab specimens. These PCR results were found to have no detectable correlation for clinical disease. The main outcome measures in this follow-up study were the reported prevalence of respiratory tract infections, asthma and allergy. RESULTS: Approximately 83% completed the follow-up questionnaire. No increase in respiratory tract infections was reported by children previously found to have C. pneumoniae infection. A diagnosis of allergy was more common in the former PCR-negative population (13.4% vs 4.7%, p<0.03). The differences were most apparent in the population with atopic heredity. In a logistic regression model with different suggested risk factors for allergy, earlier infection with C. pneumoniae reduced the risk for allergy (OR=0.13; 95% CI: 0.02-0.99). This was not found for asthma. CONCLUSION: A positive PCR test for C. pneumoniae in young children was associated with a lower risk of developing allergic airway disease in this study population, and did not predict an increase in respiratory tract infections.