Availability and use of rapid diagnostic tests for the management of acute childhood infections in Europe: A cross-sectional survey of paediatricians.

BACKGROUND: Point-of-care-tests (POCTs) have been advocated to optimise care in patients with infections but their actual use varies. This study aimed to estimate the variability in the adoption of current POCTs by paediatricians across Europe, and to explore the determinants of variability. METHODS AND FINDINGS: A cross-sectional survey was conducted of hospital and primary care paediatricians, recruited through professional networks. Questions focused on the availability and use of currently available POCTs. Data were analysed descriptively and using Median Odds Ratio (MOR) to measure variation between countries. Multilevel regression modelling using changes in the area under the receiver operating characteristic curve of models were used to assess the contribution of individual or workplace versus country level factors, to the observed variation. The commonest POCT was urine dipsticks (UD) which were available to >80% of primary care and hospital paediatricians in 68% (13/19) and 79% (23/29) countries, respectively. Availability of all POCTs varied between countries. In primary care, the country (MOR) varied from 1.61 (95%CI: 1.04-2.58) for lactate to 7.28 (95%CI: 3.04-24.35) for UD. In hospitals, the country MOR varied from 1.37 (95%CI:1.04-1.80) for lactate to 11.93 (95%CI:3.35-72.23) for UD. Most paediatricians in primary care (69%, 795/1154) and hospital (81%, 962/1188) would use a diagnostic test in the case scenario of an infant with undifferentiated fever. Multilevel regression modelling showed that the country of work was more important in predicting both the availability and use of POCTs than individual or workplace characteristics. CONCLUSION: There is substantial variability in the adoption of POCTs for the management of acute infections in children across Europe. To inform future implementation of both existing and innovative tests, further research is needed to understand what drives the variation between countries, the needs of frontline clinicians, and the role of diagnostic tests in the management of acute childhood infections.

Vaccination Attitudes and Experiences of Medical Doctors in Croatia amid the COVID-19 Pandemic: A Social Roles Conflict?

The study aimed to investigate the range of experiences and attitudes of Croatian medical doctors (MDs) related to vaccination and vaccine hesitancy. In January 2021 three asynchronous online focus groups were held using MRQual, a web-based platform, which included 46 MDs from all three levels of the healthcare system in Croatia. NVivo, a qualitative data analysis software package, was used for the thematic analysis of collected data. The participants expressed a high level of support for the Croatian immunization program and vaccines in general. However, some skepticism was expressed regarding new vaccines and the regulatory processes of their approval. A significant number of participants raised concerns over the approval of COVID-19 vaccines, especially given their rapid development. The results also revealed that the process of communication with patients is often based on the very elaborate categorizations of patients based on previous experience, which leads to prioritizing and a communication breakup when dealing with "problematic patients". MDs find themselves in a delicate situation where a fine balance between time-consuming communication with patients and the demands for maintaining satisfying vaccination uptake is needed. The situation arises from a social roles conflict that is embedded in wider social values and expectations, since communication problems do not arise in the doctor's office, and therefore cannot be solved without addressing the social forces that cause trust deficiencies. To achieve better immunization results public health leaders need to better understand the social contexts and constraints of MDs vaccine-related behaviors.

COVID-19 Era Effect on Pandemic and Post-pandemic Pediatric Telemedicine Use: A Survey of the European Academy of Pediatrics Research in Ambulatory Settings Network.

Background: During the COVID-19 pandemic, telemedicine use has increased within community pediatrics. This trend runs counter to reluctance to adaptation of the new mode of healthcare that existed prior to the pandemic. Little is known about what we can expect after the pandemic: if physicians will opt for telemedicine modalities and if tele-pediatrics will continue to be a significant mode of community pediatric care. Objective: The goal of this study was to survey primary pediatric care providers as to their experiences and clinical decision making with telemedicine modalities prior to and during the COVID-19 pandemic, as well as their projected use after the pandemic ends. Material and methods: Using the EAPRASnet database we surveyed pediatricians throughout Europe, using a web-based questionnaire. The survey was performed during the COVID-19 pandemic (June-July 2020), assessed telemedicine use for several modalities, prior to and during the pandemic as well as predicted use after the pandemic will have resolved. Participants were also surveyed regarding clinical decision making in two hypothetical clinical scenarios managed by telemedicine. Results: A total of 710 physicians participated, 76% were pediatricians. The percentage of respondents who reported daily use for at least 50% of all encounters via telemedicine modalities increased during the pandemic: phone calls (4% prior to the pandemic to 52% during the pandemic), emails (2-9%), text messages (1-6%), social media (3-11%), cell-phone pictures/video (1-9%), and video conferencing (1-7%) (p < 0.005). The predicted post-pandemic use of these modalities partially declined to 19, 4, 3, 6, 9, and 4%, respectively (p < 0.005), yet demonstrating a prospectively sustained use of pictures/videos after the pandemic. Reported high likelihood of remotely treating suspected pneumonia and acute otitis media with antibiotics decreased from 8 to 16% during the pandemic to an assumed 2 and 4% after the pandemic, respectively (p < 0.005). Conclusions: This study demonstrates an increased utilization of telemedicine by pediatric providers during the COVID-19 pandemic, as well as a partially sustained effect that will promote telemedicine use as part of a hybrid care provision after the pandemic will have resolved.

Bullying and Attitudes Toward Masculinity in Croatian Schools: Behavioral and Emotional Characteristics of Students Who Bully Others.

Prevention of bullying is paramount to creating a positive and welcoming school environment. This study compared the following characteristics reported by students who had perpetrated bullying in Croatian schools and those who did not: gender, type of school, family wealth, negative emotionality, behaviors that may compromise health, and endorsement of traditional masculinity. Within the framework of the "Croatian Adolescent Masculinity Study," second and third grade students of secondary schools (equivalent to tenth and eleventh grade in the United States) in the city of Zagreb (N = 4,072) completed a cross-sectional, paper-and-pencil survey. Descriptive and logistic regression analyses were conducted separately for males and females to identify constructs associated with bullying perpetration. More males (12.7%) than females (5.8%) perpetrated bullying. Compared to students who did not report bullying others, significantly more students, who perpetrated bullying reported feeling sad or hopeless, having suicidal ideation, carrying a weapon, missing school because of feeling unsafe, drinking alcohol, getting inebriated, being victims of bullying, and endorsing traditional masculinity norms. The proportion of males reporting bullying others did not vary by type of school; females were more likely to perpetrate bullying in predominantly male and mixed-gender vocational schools. Bullying prevention interventions should address the complexity of problems associated with bullying others. Students who reported bullying others were more likely to participate in other harmful behaviors and have emotional problems. Endorsement of traditional masculinity norms should be further researched in other cultures and included in investigations of bullying perpetration, given its association with increased bullying among male and female students.

Vaccine confidence among parents: Large scale study in eighteen European countries.

BACKGROUND: Despite the fact that vaccines save 2-3 million lives worldwide every year, a percentage of children are not getting appropriately vaccinated, thus leading to disease outbreaks. One of the major reasons of low vaccine uptake in Europe is vaccine hesitancy, contributing to the recent measles outbreaks. Monitoring of vaccine hesitancy is valuable in early identification of vaccine concerns. METHODS: We performed an eighteen country European survey on parents' attitudes and behaviors regarding their children's immunization. Parents having at least one child 1-4 years old were mostly recruited by primary care paediatricians to reply to a web-based questionnaire. The questionnaire was developed by the European Academy of Paediatrics Research in Ambulatory Setting Network steering committee, based on similar surveys. An individual level hesitancy score was constructed using the answers to 21 questions, and correlations of the score with socio-demographic characteristics and types of providers were explored. To assess inter country differences, a country level self -reported confidence was defined. RESULTS: Fifty six percent and 24% of 5736 respondents defined themselves as "not at all hesitant", and "somewhat hesitant", respectively. Parents who consulted general practitioners were more hesitant than parents who consulted pediatricians (p < 0.05). Consultation with homeopathists was associated with the highest reported hesitancy (p < 0.05). Vaccine confidence was highest in Portugal and Cyprus, and lowest in Bulgaria and Poland. CONCLUSION: The majority of parents in Europe believe in the importance of childhood vaccination. However, significant lack of confidence was found in certain European countries, highlighting the need for continuous monitoring, awareness and response plans. The possible influence of different types of healthcare providers on parental decisions demonstrated for the first time in our survey, calls for further research. Monitoring and continuous medical education efforts aimed mostly at those professionals who might not be likely to recommend vaccination are suggested.

Analysis of data on breastfeeding in Croatia from 2005 to 2016.

Aim To analyse available breastfeeding data in Croatia and to describe the process of gathering, collecting, recording and reporting on them to the official institutions. Methods Infant nutrition data collected at maternity wards and infant nutrition data from primary health care units during the period 2005 to 2016 have been used. Descriptive statistics was used to analyse the data and to show the trends in breastfeeding. Results More than 85% of newborns were exclusively breastfed in the maternity wards. Data on breastfeeding from primary health care showed growth in exclusive breastfeeding up to 2011, followed by a fall in 2013. From 2012, paediatric teams had the obligation to join information system (CEZIH), but electronic forms did not contain infant nutrition information. Similarly in the E-Newborn project (E-novorodence) the question on the feeding method in the application was not designated as mandatory. Conclusion The routinely collected data on breastfeeding did not allow us to draw any conclusion regarding breastfeeding trends in Croatia. In order to improve the process of gathering, recording and reporting data on breastfeeding to the proper authorities, it would be necessary to clearly align definitions, employ a uniform methodology, and upgrade the computer applications in primary health-care. Only then may the reports required for compulsory health insurance be obtained via the CEZIH, as well as the public health reports necessary to monitor preventive work in care of children's health, and monitoring public health indicators.

Nutrition Counselling Practices among General Practitioners in Croatia.

Chronic non-communicable diseases are a significant public health problem and imbalanced nutrition is one of the most significant risk factor for them. The objective of this study was to examine Croatia's general practitioners' nutrition counselling practice and determine the factors that influence such practice. A cross-sectional study was conducted among 444 (17.0%) randomly selected general practitioners (GPs) in Croatia from May to July 2013 via a 32-item anonymous questionnaire. Study showed that 77.0% of participants had provided nutrition counselling exclusively to patients with specific health risks; 18.7% participants had provided nutrition counselling for all patients, regardless of their individual risks, while 4.3% had not provide nutrition counselling. As the most significant stimulating factor for implementing nutrition counselling in their daily work with patients, 55.6% of the participants identified personal interest regarding nutrition and the effects it has on health. The latter factor was more frequently emphasized among female general practitioners (p < 0.001) and general practitioners without chronic diseases (p < 0.001). The most significant barrier for nutrition counselling was lack of time (81.6%). It is necessary to make additional efforts to increase the frequency of nutrition counselling provided by general practitioners in Croatia. The majority of Croatian general practitioners could increase their nutrition counselling practice in order to promote balanced nutrition and improve the overall health status of their patients.

Transgenerational Transmission of Violence among Parents of Preschool Children in Croatia.

The aim of this study was to determine whether there is a transgenerational transmission of violence within the family on a sample of parents of preschool children in Croatia, and to identify the factors that increase the likelihood of child abuse. The Child Abuse Questionnaire was self-administered to the sample of 118 parents of preschool children (91 mothers and 27 fathers) during February 2013. There were 7.7% of mothers and 3.8% of fathers who answered that they slapped their child, while 15.4% of the fathers answered that they even hit their child with a fist. We found the subjects who were psychologically and/or physically abused in childhood by their parents to have a higher probability of following the exact model of violence on their children. So, children suffer physical violence in larger families from parents who, in turn, suffered physical violence in childhood from their fathers, controlled for all other factors in the model. Children suffer psychological violence from parents who experienced psychological violence from their own parents during childhood, controlled for all other factors in the model. We also found the higher number of family members in a household to be a risk factor for abuse. The study has confirmed that additional interventions are necessary to break the model of transmitting violence from generation to generation.

The Child Health Care System of Croatia.

The Republic of Croatia is a Parliamentary Republic with a population of 4.2 million people that sits on the Adriatic coast within Central Europe. Gross domestic product is approximately 60% of the European Union average, which in turn, limits health service spending. The health system is funded through universal health insurance administered by the Croatian Health Insurance Fund based on the principles of social solidarity and reciprocity. The children of Croatia are guaranteed access to universal primary, hospital, and specialist care provided by a network of health institutions. Pediatricians and school medicine specialists provide comprehensive preventive health care for both preschool and school-aged children. Despite the Croatian War of Independence in the late 20th century, indicators of child health and measures of health service delivery to children and families are steadily improving. However, similar to many European countries, Croatia is experiencing a rise in the "new morbidities" and is responding to these new challenges through a whole society approach to promote healthy lifestyles and insure good quality of life for children.

Comparison of knowledge, attitudes and behaviour of health professionals and parents regarding child injuries.

OBJECTIVE: We wanted to primarily examine the knowledge, attitudes and behaviour of parents and health workers (community nurses and paediatricians) regarding child injuries in order to understand the essence of the problem and to find out the most common misconceptions. METHODS: Respondents were tested through an anonymous, self-administered questionnaire and all p values below 0.05 were considered significant. RESULTS: Of all respondents, paediatricians answered accurately most of the questions considering knowledge than the other groups. More than 90% of respondents, in all groups, identified correct answers to 10 questions about attitudes towards child injury prevention and safety promotion. CONCLUSION: This study, which shows the current level of knowledge, attitudes and behaviour patterns of parents and health professionals in Croatia, could help in the preparation of appropriate prevention programmes.

Healthcare providers' knowledge, attitudes and counselling on injury prevention for preschool children in Croatia.

Injuries are the leading cause of death for children and young adults in Croatia. Research has indicated that health care providers can be effective in reducing the risk for traumatic injury through anticipatory guidance, but successful guidance requires that providers have injury knowledge and informed safety attitudes. This is the first study in Croatia to identify health care provider's knowledge, attitudes, and practices regarding anticipatory guidance on injury prevention for children. A stratified, random sample of licensed Croatian healthcare providers was mailed a survey, with a response of rate of 39.5 %. Participants included pediatricians, family physicians, gynecologists, each with a focus on primary care, and community nurses. Participants filled out a 15-minute paper-and-pencil survey that tested their knowledge of injury risks and prevention strategies, assessed their safety-prone attitudes, and measured the extent to which they counselled their patients on injury prevention. Pediatricians had the highest knowledge of injury risks and intervention approaches, with an average correct score of six out of ten (significantly higher than all other provider types). Knowledge was highest regarding infant fall risk and lowest for safe sleep positions. Pediatricians and community nurses had the highest safety-prone attitudes. Safety prone attitudes were strongest for transportation safety and weakest for safe sleeping position for all providers. Community nurses reported the highest level of patient counselling, followed by pediatricians. Both factual education and support in translating knowledge into everyday practice are necessary for health care providers. Implementing anticipatory guidance for child safety is a promising approach in Croatia.

[Children with injuries treated in hospital emergency departments]. / Djeca s ozljedama lijecena u bolnickim ambulantama hitnog prijma.

The aim of this study was to determine characteristics of injuries of children admitted to the Emergency Department (ED) of University Hospital Split, and also to define the mechanisms of injuries, as well as the type and severity of injuries. We evaluated 3,221 children with injuries treated in the ED of the University Hospital of Split in the period from January to July 2009. The following indicators were analyzed: age, gender, anatomic distribution of injuries, mechanism, Injury Severity Score (ISS) and the need for hospital and intensive care admission. Chi-square and Mann-Whitney tests were used in order to determine statistical relevance of the results. Boys were more often injured than girls (65.6%), and most of the injured children were older than 13 years (41.7%). The majority of patients (96%) had minor injuries (ISS < 10), and only 3.7% of patients were hospitalized. The majority of injuries were caused by falls (71.3%), and limbs were the most frequently injured body region (67.1%). However, road traffic accidents (RTA) required hospitalization more often than any other mechanism (25% of patients), and the leading injury in RTA victims was head injury (38% of patients). Older children were more susceptible to RTAs (64.5%), and the majority of children were injured as passengers in cars (36.4%). Children with head injuries, and those injured in RTAs, were more often hospitalized and more often admitted to intensive care unit than other patients. The most frequently injured body region in children treated in ED are limbs, and the most frequent mechanism of injury is fall. However, the most severe are head injuries, and the majority of severe injuries are caused by RTAs. These data are important for programs of injury prevention.

Enuresis in school children from eastern Croatia.

The aim of this study was to establish the prevalence of nocturnal incontinence (NI) in 6-to-7-year-old children from eastern Croatia, to determine the factors associated with NI and to evaluate parental perception of the problem. From May to September 2004, the parents of 3,011 children were asked to complete an anonymous validated questionnaire. The overall prevalence of reported NI was 1.2% (35/3011). All of the cases were cases of secondary NI. NI was significantly more frequent in boys than in girls. Family history of enuresis was present in 68.6% (24/35) of enuretic children. Only 17.1% (6/35) of parents expressed some concern about the effect of the researched problem on their child's future development. The frequency of NI in this study group is much lower than that reported in other European countries. The reason for this is still not known, although parental perception of this problem is certainly a significant factor. Further investigations are needed.

[Child in contemporary Croatian society]. / Dijete u suvremenome hrvatskom drustvu.

The symposium on the topic "Child in contemporary Croatian society", organized by Croatian Pediatric Society, Croatian Academy of Sciences and Arts, Ministry of health and social welfare and UNICEF Croatia Office, was held in Zagreb on December 12, 2009. The lecturers have shown important information on difficulties the children in Croatia are exposed to. Namely, diseases of the so called "new morbidity", which are becoming more and more frequent in the contemporary world, demand a new approach of work from all who participate in healthcare for children, including additional education. These diseases are not part of a practitioner's routine activity. Due to variety of problems children are exposed to, the approach can be only multidisciplinary. Basic national interest of every country (basic interest of every human society) should be to direct more attention and financial resources to the healthcare of children, which would ensure the existence and healthy future of the society. This approach requires a national consensus and clear political decision of all responsible official services.