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1.
Arch Dis Child ; 105(1): 40-46, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31270093

RESUMO

BACKGROUND AND OBJECTIVES: Adolescent sexual and reproductive health and rights (SRHR) are of particular relevance given their potential short-term or long-term health consequences. This study evaluates recommendations and policies regarding access to care in this area in 31 European countries (European Union (EU) plus Iceland, Norway and Switzerland). METHODS: As part of the EU funded Models of Child Health Appraised project, data were gathered using a 43-item questionnaire sent to experts responsible for collecting information in each country. RESULTS: Ten countries have not developed any formal policy or recommendation that guarantee the respect of confidentiality and the possibility of consulting a physician without parents knowing. Nearly half of the countries do not have centres specialised in adolescent healthcare, tackling comprehensive health issues or focusing specifically on SRH. Access to emergency contraception and information regarding pregnancy, including testing, is easy in most countries. However, oral contraception is delivered free of charge in only 10 countries. Twenty-three countries do not meet current standards in terms of providing policy-based pregnancy care, and only 13 have set up special programmes for pregnant adolescents. In only seven countries can adolescents definitely have their pregnancy terminated without their parents knowing (and in another seven countries in selected situations). CONCLUSION: The provision and availability of adolescent-friendly SRHR care are far from optimal in around half of the surveyed countries. These results call for the review and implementation of policies, specialised healthcare centres and training initiatives for primary care providers.

2.
BMC Public Health ; 19(1): 839, 2019 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-31248395

RESUMO

BACKGROUND: The main objective of this study was to explore the contextual determinants of child health policies. METHODS: The Horizon 2020 Models of Child Health Appraised (MOCHA) project has one Country Agent (CA) in all 30 EU and EEA countries. A questionnaire designed by MOCHA researchers as a semi-structured survey instrument asked CAs to identify and report the predominating public and professional discussions related to child health services within the last 5 years in their country and the various factors which may have influenced these. The survey was issued to CAs following validation by an independent Expert Advisory Board. The data were collected between July and December 2016. The data was qualitatively analysed using software Nvivo11 for data coding and categorization and constructing the scheme for identified processes or elements. RESULTS: Contextual determinants of children's health care and policy were grouped into four categories. 1) Socio-cultural determinants: societal activation, awareness, communication, trust, freedom, contextual change, lifestyle, tolerance and religion, and history. 2) Structural determinants which were divided into: a) external determinants related to elements indirectly correlated with health care and b) internal determinants comprising interdependent health care and policy processes. 3) International determinants such as cross-nationality of child health policy issues. 4) The specific situational determinants: events which contributed to intensification of debates which were reflected by behavioural, procedural, institutional and global factors. CONCLUSIONS: The influence of context across European countries, in the process of children's health policy development is clearly evident from our research. A number of key categories of determinants which influence child health policy have been identified and can be used to describe this context. Child health policy is often initiated in reaction to public discontentment. The multiple voices of society resulted, amongst others, in the introduction of new procedures, action plans and guidelines; raising levels of awareness, intensifying public scrutiny, increasing access and availability of services and provoking introduction of structural changes or withdrawing unfavourable changes.


Assuntos
Saúde da Criança , Política de Saúde , Formulação de Políticas , Criança , Serviços de Saúde da Criança , Europa (Continente) , Humanos , Pesquisa Qualitativa , Inquéritos e Questionários
3.
J Child Health Care ; 23(3): 343-357, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31132868

RESUMO

Children's rights to autonomy of choice are differently expressed throughout Europe. We explored differences regarding expressions of respect for children's autonomy throughout Europe, using the procedure of human papillomavirus (HPV) vaccination offer as indicator. We used a mixed methods approach, utilizing an expert survey within the frame of "Models of Child Health Appraised" (MOCHA), among all 30 European Union (EU) and European Economic Area states. A questionnaire was designed using vignettes regarding the vaccine provision. Thirty MOCHA country agents were invited to respond from June 2017 to April 2018. In total, 28 country agents responded. We studied the following themes: (i) provision of informed consent, (ii) parental and medical paternalism, (iii) relevance of the child's chronological age or maturity, and (iv) vaccination programs targeting boys. These are being handled differently across the region. We explored associations of these implemented practices with the national vaccine coverage rate across Europe. We used the processes of HPV vaccination to study child's autonomy, the paradigm change toward libertarian paternalism and issues of sex-equity. Interestingly, greater respect for children's autonomy tends to be associated with medium or high vaccination coverage rates and lower respect with lower rates. Respect and empowerment seem to have practical as well as moral benefits. Identifying and transferring the most suitable ethical approaches is crucial and should be strengthened.

4.
Inquiry ; 56: 46958019833869, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30845863

RESUMO

To adopt and implement innovative good practices across the European Union requires developing policies for different political and constitutional contexts. Health policies are mostly decided by national political processes at different levels. To attain effective advice for policy making and good practice exchange, one has to take different models of governance for health into account. We aimed to explore which concepts of governance research are relevant for implementing child health policies in a European Union context. We argue that taking into account the insights of good intersectoral and multilevel governance in research and practice is essential and promising for future analyses. These governance concepts help to understand what actors and institutions are potentially of relevance for developing and implementing child-centric health care approaches not only within health care but also outside health care. The framework we developed has the potential to advise on and thus support effectively the spreading and implementation of good practices of child-centric health policy approaches across the European Union. With this heuristic framework, the variety of relevant stakeholders and institutions can better be mapped and taken into account in implementation processes. Also, the normative side-particularly stressing values that make governance "good governance"-is to be taken into account.


Assuntos
Saúde da Criança , Política de Saúde , Heurística , Formulação de Políticas , Atenção Primária à Saúde , Criança , Tomada de Decisões , União Europeia , Humanos , Política
5.
Child Care Health Dev ; 45(3): 364-370, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30874322

RESUMO

BACKGROUND: In the European context the awareness of societal responsibility for children's health has increased with greater attention to children's rights and child empowerment processes. Child health issues are considered particularly sensitive; thus, they often provoke strong societal reactions, which, as a consequence, influence national health policies across Europe. Effectiveness of societal influences increases with the involvement of various actors in the context. METHODS: A qualitative approach was used to identify the level of societal involvement in health decision-making. A questionnaire was sent to the Country Agents (CAs) of the Models of Child Health Appraised (MOCHA) project. CAs are contact points in each of the 30 participating in the project countries and were asked to identify strong public and professional discussions related to child health services in their countries. Data collection was undertaken between July and December 2016. RESULTS: Based on 71 case studies, we identified eight thematic patterns, which characterize societal reactions to the currently worrisome child health issues across Europe. We devoted our attention to the three most controversial: child vaccination, child poverty and child abuse. The cases described by the CAs show the broad perspective in the perception of child health problems. Child health issues involve the public and raise nationwide debates. Public concerns were directly or indirectly related to child health and depicted the national overtone. CONCLUSIONS: Concerns in Europe about child health care are twofold: they are devoted to systemic issues (indirect patient orientation) and to child health and well-being (direct patient orientation). The phenomenon of societal responsibility for children's health is important for the support of public acceptance of child health policy.

6.
Lancet Child Adolesc Health ; 2(11): 822-831, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30336896

RESUMO

With improvements in neonatal and paediatric care, more children living with complex care needs are surviving beyond infancy into late childhood and adulthood than in the past. We examined the current approach to the management and integration of care of children living with complex care needs in 30 European countries, as well as the implications for primary care service delivery. This descriptive study, with an embedded qualitative aspect, consisted of questions adapted from the Standards for Systems of Care for Children and Youth with Special Health Care Needs, and included questions on a complex care European survey of change, adapted from the Eurobarometer survey. The analysis indicates that few systems are in place in countries across Europe to identify all the health-care providers who deliver care to a child living with complex care needs, and that less than half of all countries surveyed have policies in place to support care coordination for these children. Primary care physicians have little involvement in care planning for children before their discharge to the community setting, and there is little parental participation in policy development. Access to, and governance of, care for these children varies widely. Particular issues identified pertain to parents as catalysts of optimum integration of care, pathways to specialist care, and the need for comprehensive national integrated care programmes.


Assuntos
Serviços de Saúde da Criança , Doença Crônica/terapia , Prestação Integrada de Cuidados de Saúde , Necessidades e Demandas de Serviços de Saúde , Atenção Primária à Saúde , Adolescente , Lesões Encefálicas Traumáticas/terapia , Criança , Serviços de Saúde da Criança/normas , Prestação Integrada de Cuidados de Saúde/normas , Epilepsia Resistente a Medicamentos/terapia , Europa (Continente) , Feminino , Humanos , Lactente , Pneumopatias/terapia , Masculino , Atenção Primária à Saúde/normas , Relações Profissional-Família , Garantia da Qualidade dos Cuidados de Saúde , Respiração Artificial , Apoio Social
7.
Lancet Child Adolesc Health ; 2(11): 832-838, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30336897

RESUMO

This Viewpoint presents and discusses the development of the first core principles and standards for effective, personalised care of children living with complex care needs in Europe. These principles and standards emerged from an analysis of data gathered on several areas, including the integration of care for the child at the acute-community interface, the referral-discharge interface, the social care interface, nursing preparedness for practice, and experiences of the child and family. The three main principles, underpinned by a child-centric approach, are access to care, co-creation of care, and effective integrated governance. Collectively, the principles and standards offer a means to benchmark existing services for children living with complex care needs, to influence policy in relation to service delivery for these children, and to provide a suite of indicators with which to assess future service developments in this area.


Assuntos
Serviços de Saúde da Criança , Doença Crônica/terapia , Prestação Integrada de Cuidados de Saúde , Necessidades e Demandas de Serviços de Saúde , Atenção Primária à Saúde , Criança , Serviços de Saúde da Criança/normas , Prestação Integrada de Cuidados de Saúde/normas , Europa (Continente) , Humanos , Atenção Primária à Saúde/normas , Relações Profissional-Família , Garantia da Qualidade dos Cuidados de Saúde , Apoio Social
8.
Stud Health Technol Inform ; 247: 61-65, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29677923

RESUMO

Models of child primary health care vary across Europe. There are three categories, primary care paediatricians, general practitioner based, or mixed. This paper describes the metadata schema used in the profiling process of candidate data sources for appraisal for the Models of Child Health Appraised (MOCHA) project using the MOCHA International Research Opportunity Instrument (MIROI). The ten clinical indicators included: asthma, antibiotic stewardship, immunisation, rickets, diarrhea, epilepsy, depression, ADHD, enuresis and care of women during pregnancy. Our metadata allows us to identify data within included data sources concerning any of the 10 clinical indicators identified for comparative analysis within the MOCHA project. From the 30 countries we found a minimum of 5 and a maximum of 36 different databases for each indicator.


Assuntos
Saúde da Criança , Bases de Dados Factuais , Atenção Primária à Saúde , Criança , Europa (Continente) , Feminino , Programas Governamentais , Humanos , Gravidez , Indicadores de Qualidade em Assistência à Saúde
9.
Stud Health Technol Inform ; 244: 8-12, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29039367

RESUMO

Computerised medical record (CMR) system data can be used to compare different models of health care for children. We identified sources of data from the Models of Child Health Appraised (MOCHA) project that compares family doctor led with paediatrician led and mixed models of child care using index conditions. Asthma and immunisation coverage are the first of these. We explored the extent to which an established Patient Registries Initiative (PARENT); MOCHA's own survey (MIROI); the European Centre for Disease Control (ECDC) immunisation information system survey and the European Network of Centres for Pharmacoepidemiology and Pharmacovigilance (ENCePP) registry of data sources provided data to make comparisons of child health care. Five countries had data repositories for our index conditions from paediatrician lead services, compared with 14 for mixed, and 11 for family doctor led services. PARENT identified 212 sources, MIROI 148 sources, ECDC 17 sources and ENCePP 42; with immunisation related data sources found in all four but asthma in only three. There are less sources of electronic data available to study paediatrician led systems than other models; this risks unequal sample size bias.


Assuntos
Sistemas Computadorizados de Registros Médicos , Atenção Primária à Saúde , Criança , Saúde da Criança , Europa (Continente) , Humanos , Registros Médicos
10.
Z Gesundh Wiss ; 23(2): 87-94, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25798371

RESUMO

AIM: Childhood obesity is an important concern for child health. However, despite widespread concern about the increase in childhood obesity, its causes are not monitored systematically in Europe. In 2007, the Scientific Platform Project on Lifestyle Determinants of Obesity identified routine data sources nationally available in European countries to measure childhood obesity. This work was revisited in 2014 to monitor any progress made. SUBJECT AND METHODS: In 2007, a literature review and project discussion resulted in a list of desirable indicators that could be collected in Europe to describe child populations at risk of overweight and obesity. Participants from EU member states, the EEA, Croatia, Macedonia and Turkey set out to discover which countries collected these indicators. Eight years later, a literature search sought to establish if the surveillance of children's nutrition and physical activity behaviour had changed. RESULTS: In 2007, no countries collected all variables for all ages, leading to major gaps in knowledge. A literature search carried out in 2014 suggests that this is unchanged. There remains inconsistency of data surveillance in Europe, and disagreement on which age groups to collect data from or how to define obesity and overweight. CONCLUSION: There is a lack of consistent data collection on upstream influences on obesity. The true causes of the childhood obesity epidemic remain undiscovered, and the ability of research to identify effective prevention and treatment methods is compromised.

11.
Int J Public Health ; 60(4): 449-56, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25740660

RESUMO

OBJECTIVES: Positive recent experience of presenting comparative child safety data at national level has instigated policy action in Europe. It was hoped a Child Safety Index could quantify how safe a community, region or locality is for its children in comparison with similar areas within Europe, as a focus for local targeted action. METHODS: Validated indicators proposed by previous European projects identified from areas of child injury prevention, such as road safety, burns or poisoning, were selected to give a balanced profile, and populated from available published data. An index using a sub-score for each specific injury topic was proposed. The indicators' presentation, sensitivity and appropriateness were considered, as well as data availability. RESULTS: Satisfactory indicators were not identified for all areas and very few local area data were available. This forced the researchers to conclude that at present, constructing a reliable Child Safety Index for use at the local level is not feasible. CONCLUSIONS: There is a worrying lack of data available at the sub-national level to support injury prevention, evaluate interventions, and enable informed local decision making.


Assuntos
Prevenção de Acidentes/métodos , Prevenção Primária/organização & administração , Ferimentos e Lesões/prevenção & controle , Prevenção de Acidentes/normas , Adolescente , Criança , Pré-Escolar , Europa (Continente) , Saúde Global , Educação em Saúde , Humanos , Lactente , Recém-Nascido , Prevenção Primária/normas , Avaliação de Programas e Projetos de Saúde , Fatores de Risco , Segurança , Índices de Gravidade do Trauma
12.
Int J Soc Psychiatry ; 61(3): 241-50, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25001267

RESUMO

BACKGROUND: This randomised controlled trial examined if for people with enduring mental illness, being supported to socialise leads to improved social functioning, increased self-esteem and extended social networks; a reduction in social isolation, social, emotional and family loneliness and a reduction in illness symptoms, namely depression. METHODS: A prospective randomised controlled trial was undertaken from November 2007 to September 2011. Service users with a diagnosis of enduring mental illness (>18 years) were invited to participate. Participants were randomly allocated to intervention or control group conditions in a 1:1 ratio. Intervention group participants were matched with a volunteer partner, asked to engage in social/leisure activities for 2 hours weekly over a 9-month period, and received a €20 stipend monthly. Control group participants received a €20 monthly stipend and were asked to engage in a weekly social/leisure activity. Social functioning, the primary outcome, was measured using the Social Functioning Scale (SFS) at three time points (baseline, midpoint and endpoint). FINDINGS: In all, 107 people completed this study. There were no significant differences between control and intervention groups at the commencement of the intervention on demographic characteristics or the main outcome measures of interest. Overall social functioning positively changed throughout the three time points from a mean of 99·7 (standard deviation (SD) = 15.1) at baseline, to a mean of 106.0 (SD = 27.0) at the endpoint for the control group, and from a mean of 100·4 (SD = 15.0) at Time 1 for the intervention group, to a mean of 104.1 (SD = 23.4) at the endpoint for the intervention group. CONCLUSIONS: The intervention showed no statistical differences between the control and intervention groups on primary or secondary outcome measures. The stipend and the stipend plus volunteer partner led to an increase in recreational social functioning; a decrease in levels of social loneliness, in depression and in the proportion living within a vulnerable social network.


Assuntos
Depressão/psicologia , Solidão/psicologia , Transtornos Mentais/diagnóstico , Participação Social , Apoio Social , Socialização , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Autoimagem , Resultado do Tratamento
13.
Pediatr Blood Cancer ; 59(4): 753-5, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22315235

RESUMO

Arsenic trioxide was tested against the PPTP in vitro panel (1.0 nM to 10 µM) and against the PPTP Ewing sarcoma in vivo panel administered intraperitoneally at a dose of 2.5 mg/kg daily × 5 per week for a planned treatment duration of 3 weeks. Arsenic trioxide showed a median relative IC(50) value of 0.9 µM, with Ewing sarcoma cell lines having IC(50) values similar to those of the remaining PPTP cell lines. Arsenic trioxide did not induce significant differences in EFS distribution compared to control in any of the Ewing sarcoma xenografts studied, and no objective responses were observed.


Assuntos
Arsenicais/uso terapêutico , Neoplasias Ósseas/tratamento farmacológico , Inibidores do Crescimento/uso terapêutico , Óxidos/uso terapêutico , Sarcoma de Ewing/tratamento farmacológico , Ensaios Antitumorais Modelo de Xenoenxerto , Animais , Trióxido de Arsênio , Linhagem Celular Tumoral , Feminino , Camundongos , Camundongos SCID
14.
Pediatr Blood Cancer ; 59(1): 185-8, 2012 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-21538821

RESUMO

AT13387, a non-geldanamycin inhibitor of heat-shock protein 90 (HSP90), was tested against the PPTP in vitro panel (1.0 nM to 10 µM) and against the PPTP in vivo panels (40 or 60 mg/kg) administered orally twice weekly. In vitro AT13387 showed a median EC(50) value of 41 nM and exhibited activity consistent with a cytotoxic effect. In vivo AT13387 induced significant differences in EFS distribution compared to controls in 17% evaluable solid tumor xenografts, but in none of the ALL xenografts. No objective tumor responses were observed. In vivo AT13387 demonstrated only modest single agent activity.


Assuntos
Benzamidas/farmacologia , Benzamidas/farmacocinética , Proteínas de Choque Térmico HSP90/antagonistas & inibidores , Isoindóis/farmacologia , Isoindóis/farmacocinética , Neoplasias/tratamento farmacológico , Ensaios Antitumorais Modelo de Xenoenxerto , Animais , Linhagem Celular Tumoral , Criança , Pré-Escolar , Relação Dose-Resposta a Droga , Feminino , Humanos , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Nus , Camundongos SCID , Neoplasias/metabolismo
15.
Pediatr Blood Cancer ; 59(4): 749-52, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22052829

RESUMO

The PIM kinase inhibitor, SGI-1776, was tested against the PPTP in vitro (1.0 nM-10 µM) and in vivo panels (148 mg/kg daily × 5 days for 3 weeks). SGI-1776 exhibited cytotoxic activity in vitro with a median relative IC(50) of 3.1 µM. SGI-1776 induced significant differences in EFS distribution in vivo in 9 of 31 solid tumor xenografts and in 1 of 8 of the evaluable ALL xenografts. SGI-1776 induced tumor growth inhibition meeting criteria for intermediate EFS T/C activity in 1 of 39 evaluable models. In contrast, SGI-1776 induced complete responses of subcutaneous MV4;11 (B myeloid leukemia).


Assuntos
Imidazóis/uso terapêutico , Proteínas Proto-Oncogênicas c-pim-1/antagonistas & inibidores , Piridazinas/uso terapêutico , Proteínas Adaptadoras de Transdução de Sinal/metabolismo , Animais , Linhagem Celular Tumoral/efeitos dos fármacos , Proliferação de Células/efeitos dos fármacos , Ensaios de Seleção de Medicamentos Antitumorais , Imidazóis/farmacologia , Camundongos , Camundongos Endogâmicos NOD , Camundongos SCID , Neoplasias/metabolismo , Fosfoproteínas/metabolismo , Proteínas Proto-Oncogênicas c-pim-1/metabolismo , Piridazinas/farmacologia , Ensaios Antitumorais Modelo de Xenoenxerto
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