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Primary care in pediatrics: the situation in Europe

Per richiamare l’attenzione sull’importanza delle cure primarie l’OMS ha di recente lanciato lo slogan Primary health care -Now more than ever (The world health report. WHO, 2008). Se da un lato sembra ovvio che la figura di riferimento delle cure primarie in età pediatrica debba essere il pediatra (Cheng TC. Pediatrics 2004;113:1802-9), risultati soddisfacenti in termine di indicatori di salute pediatrica sono stati ottenuti anche in alcuni Paesi che escludono il pediatra dalle cure primarie (Katz M, et al. Pediatrics 2002;1098:788-96). Laddove è il medico di famiglia a occuparsi in prima battuta del bambino il dibattito è aperto su quanta pediatria il medico sappia effettivamente, sulle sue capacità di selezionare correttamente i bambini da inviare in ospedale e sulla scarsa garanzia data da questo sistema in termini di azione preventiva. Nei Paesi in cui le cure primarie ai bambini sono erogate da specialisti pediatri si teme invece che l’accesso non selezionato e diretto allo specialista pediatra produca un eccesso di intervento non necessario (costoso e potenzialmente dannoso) e che in prospettiva il numero degli specialisti pediatri non sarà più sufficiente (Stephenson T, et al. Arch Dis Child 2010;95:767-8).

Uno studio sponsorizzato the European Academy of Paediatrics covering 29 countries and is the picture of the organization of pediatric primary care in Europe (Van It D, et al. Arch Dis Child 2010; 95:791-5, see also the Italian translation stated on M & B site ). Things vary considerably from country to country, from the fact that the same childhood is considered in a different way (0-14 half, 0-18 or 0-19 and the other half). The countries where pediatric primary care are handled in the first instance to the pediatrician are only 7 (Israel, Czech Republic, Slovakia, Greece, Cyprus, Spain, Slovenia) and are in sharp decline (from 35% to 23%) compared to a survey a decade ago (M. Katz Pediatrics 2002; 109:788 - 96). Cala and the proportion of countries (from 47% to 35%) who have a mixed system (among them is put Italy) in which the pediatric primary care are performed by the pediatrician but also where you can choose from different individual family or is there a different approach because of the type of intervention (preventive or clinical care). They go hand
countries where primary care pediatric pass through the filter of the general practitioner / family doctor (18% to 41%). In these countries the training of pediatric general practitioner / family doctor only lasts an average of four months. It is perhaps

a work of little use to draw conclusions: it has the objective limit of not offering any evidence to evaluate the performance of the models adopted in different countries in terms of concrete health of children. But seem to work to read, a starting point to reflect in a moment of great uncertainty and identity crisis of Pediatrics.

From Yellow Pages of Medical and Child , October 2010

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The treatment and prevention obesity of the child: experimental evidence

The central core of the issue of electronic journal of Medical and of Child October is on 'obesity , con proposte di lavoro per affrontare questo rilevante problema di salute pubblica, che hanno aspetti sicuramente interessanti e innovativi: con la "Ricerca" sui risultati preliminari di un progetto di fattibilità sulla formazione dei pediatri che viene dall'esperienza di Ferrara; con la presentazione del " Protocollo di studio" sulla prevenzione dell'obesità nei bambini tra 0-6 anni (basato su interventi evidence based), a cura della Gruppo di Lavoro sull'Obesità della Società Italiana di Pediatria Preventiva e Sociale (SIPPS).

Un invito alla lettura e a specifici commenti.

Qui di seguito i 10 interventi di prevention proposed in the study protocol "I love you "

The 10 preventive action including the indicators

	Action	indicator
1	Breastfeeding	least 6 months
2	Weaning	Introducing complementary foods after 6 months
3	protein	controls (especially in the first 2 years )
4	caloric beverages	Avoid juices, teas, soft drinks, tea , etc..
5	Bottle	be suspended within 24 months
6	Transportation	do not use the stroller after 3 years use of motorcycles and electric cars , contribute to achieving walk to school (Pedibus)
7	control BMI	Identify if there is the Early adiposity rebound (before 6 years)
8	TV, games sedentary	Only after two years, maximum 8 hours / week
9	Game and lifestyle	Offer and encourage games of movement, suitable for different age of the child
10	correct portions for preschool	Using Photo Atlas portions of food (www.scottibassani.it)

Read

work full open access:

Brambilla P, G. Bedoya G, Bongiovanni C, Brusoni G, Di Mauro G, M Di Pietro, M. Giussani M, Gnecchi M, L Iughetti, M. Sticco M, Bernasconi S. DRAFT preventing obesity in children between 0 and 6 years old "loves me" . Medical and Child
electronic pages 2010, 13 (8) http://www.medicoebambino.com/?id=PST1008_10.html

Tanas R, Caggese G, E Rossato, Desire And Limauro R, R Marcolongo . feasibility assessment project for training PEDIATRICIANS FOR THE PREVENTION AND TREATMENT OF OBESITY '. Medical and Child
electronic pages 2010, 13 (8) http://www.medicoebambino.com/?id=RIC1008_10.html

Main Topic see a doctor and Child on 'Obesity

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approved the law on Dyslexia

Good news for the families of about 350 000 Italian students with dyslexia. These children and young people with specific learning difficulties - specific learning disorders (ie dyslexia (difficulty reading), dysgraphia / dysorthography (difficulty in demonstrations graphics) and dyscalculia (difficulty in performing calculations), all disorders that have nothing to do with their intellectual abilities but are often not recognized and in some cases causing misunderstanding on the part of teachers and discouraging unnecessary or difficult to study in boys . The Senate has approved a few months away from the room, a law that protects these students. The law allocates two million euro for 2010 and 2011 (one million per year) and provides custom training, the use of compensatory measures (personal computer, calculator) and also facilities for specific examinations including graduate students and the study of foreign languages. Parents of pupils primary with these disorders, whose diagnosis is reserved for the NHS, can avail of flexible working arrangements on work permits to better assist their children in school activities. In addition there is a specific training for teachers, for the early detection of these diseases and the application of educational rehabilitation.

Under the new law teachers must be aware of the fact that to assess, in a just and fair, students with dyslexia and learning disabilities are different criteria: for example, shorter tasks, privilege Oral Questions with respect to written tests, attention the content of the topics that the spelling errors, or the ability to solve a problem rather than the knowledge of the mnemonic tables.

The law envisages the need for special training for teachers also aimed "to acquire the expertise to find early signs of trouble." Another important aspect covered by the new rules is that concerning the diagnosis to be made within the scope of specialist treatments already provided by the NHS (in legislation) will be notified by the family to home school student.

IL TESTO DELLA LEGGE

Art. 1.

(Riconoscimento e definizione di dislessia, disgrafia, disortografia e discalculia).

1. La presente legge riconosce la dislessia, la disgrafia, la disortografia e la discalculia quali disturbi specifici di apprendimento, di seguito denominati «DSA», che si manifestano in presenza di capacità cognitive adeguate, in assenza di patologie neurologiche e di deficit sensoriali, ma possono costituire una limitazione importante for some activities of daily living.
2. For the purposes of this Act, the term dyslexia is a specific disorder that manifests as a difficulty in learning to read, particularly in the decipherment of linguistic signs, or in the correctness and speed of reading.
3. For the purposes of this Act, the term dysgraphia a specific disorder that manifests itself in writing difficulties in graphic design.
4. For the purposes of this Act shall mean dysorthography a specific disorder of writing that occurs in linguistic difficulties in the process of transcoding.
5. For the purposes of this Act, the term dyscalculia is a specific disorder that manifests as a difficulties in the automation of the calculation and processing of numbers.
6. Dyslexia, dysgraphia, dyscalculia and the dysorthography may exist separately or together.
7. In the interpretation of the definitions contained in paragraphs 2 to 5, taking account of developments in scientific knowledge.

Article 2.
(Purpose).

1. This Act seeks to achieve, for people with learning difficulties, the following purposes:
a) guarantee the right to education;
b) educational success, including measures of educational support, to ensure adequate training and promoting the development of potential;
c) reduce the inconvenience and emotional relationships;
d) adopt forms of verification and assessment appropriate to the training needs of students;
s) prepare teachers and parents aware of issues in relation to the DSA;
f) promote early diagnosis and rehabilitation didactic;
g ) increase communication and collaboration between family, scuola e servizi sanitari durante il percorso di istruzione e di formazione;
h) assicurare eguali opportunità di sviluppo delle capacità in ambito sociale e professionale.

Art. 3.

(Diagnosi).

1. La diagnosi dei DSA è effettuata nell'ambito dei trattamenti specialistici già assicurati dal Servizio sanitario nazionale a legislazione vigente ed è comunicata dalla famiglia alla scuola di appartenenza dello studente. Le regioni nel cui territorio non sia possibile effettuare la diagnosi nell'ambito dei trattamenti specialist provided by the National Health Service may provide, within the limits of human resources, equipment and financial resources to existing legislation, the same diagnosis is made by specialists or accredited facilities.
2. For students who, despite adequate planning recovery activities targeted, have persistent difficulties, the school shall notify the appropriate family.
3. It is the responsibility of schools of all levels, including kindergarten, activate, after proper notice to interested families, early interventions, such as to identify suspected cases of DSA students on the basis of regional protocols for in Article 7, paragraph 1. The outcome of these activities is not, however, a diagnosis of ASD.

Article 4.
(Training at school).

1. For the years 2010 and 2011, in programs, teacher training and management of schools of all levels, including preschools, there shall be adequate preparation on issues relating to the DSA, aimed at capturing the expertise to find early signs and the consequent ability to apply teaching strategies, methodologies and proper assessment.
2. For the purposes of paragraph 1 shall be authorized an expenditure of a million euro for each of the years 2010 and 2011. The costs shall be covered through a corresponding use of the Reserve Fund for the authorized expenditure of more permanent nature of current writing in the estimates of the Ministry of Economy and Finance, as determined from Table C attached to the Law of 23 December 2009, n . 191.

Article 5.
(measures of teaching and educational support).

1. Students diagnosed with learning difficulties diritto a fruire di appositi provvedimenti dispensativi e compensativi di flessibilità didattica nel corso dei cicli di istruzione e formazione e negli studi universitari.
2. Agli studenti con DSA le istituzioni scolastiche, a valere sulle risorse specifiche e disponibili a legislazione vigente iscritte nello stato di previsione del Ministero dell'istruzione, dell'università e della ricerca, garantiscono:
a) l'uso di una didattica individualizzata e personalizzata, con forme efficaci e flessibili di lavoro scolastico che tengano conto anche di caratteristiche peculiari dei soggetti, quali il bilinguismo, adottando una metodologia e una strategia educativa adeguate;
b) l'introduzione di strumenti compensativi, compresi i mezzi di apprendimento alternativi e le tecnologie informatiche, nonché misure dispensative da alcune prestazioni non essenziali ai fini della qualità dei concetti da apprendere;
c) per l'insegnamento delle lingue straniere, l'uso di strumenti compensativi che favoriscano la comunicazione verbale e che assicurino ritmi graduali di apprendimento, prevedendo anche, ove risulti utile, la possibilità dell'esonero.

3. Le misure di cui al comma 2 devono essere sottoposte periodicamente a monitoraggio per valutarne l'efficacia e il raggiungimento degli obiettivi.
4. Agli studenti con DSA sono guaranteed during the course of education and training in schools and universities, appropriate forms of monitoring and evaluation, including on the state exams and college entrance exams and the university.

Article 6.
(measures for family members).

1. Family members until the first grade students of the first cycle of DSA involved in helping with school activities at home are entitled to take advantage of flexible working hours.
2. The procedures for exercising the right referred to in paragraph 1 shall be determined dai contratti collettivi nazionali di lavoro dei comparti interessati e non devono comportare nuovi o maggiori oneri a carico della finanza pubblica.

Art. 7.
(Disposizioni di attuazione).

1. Con decreto del Ministro dell'istruzione, dell'università e della ricerca di concerto con il Ministro della salute, previa intesa in sede di Conferenza permanente per i rapporti tra lo Stato, le regioni e le province autonome di Trento e di Bolzano, si provvede, entro quattro mesi dalla data di entrata in vigore della presente legge, ad emanare linee guida per la predisposizione di protocolli regionali, to be concluded within the next six months, for early identification of activities under Article 3, paragraph 3.
2. The Minister for Education, Universities and Research, within four months from the date of entry into force of this law, by decree, identify the mode of training of teachers and directors referred to in Article 4, the educational measures and educational support provided for in Article 5, paragraph 2, and forms of assessment and evaluation aimed at implementing the provisions of Article 5, paragraph 4.
3. By decree of the Minister of Education, University and Research, to be taken within two months from the date of entry into force of this Act, shall be established Ministry of Education, University and Research is a Scientific Committee composed of experts with proven expertise in the DSA. The Committee has the task of inquiry as to the functions that this Act gives the Ministry of Education, University and Research. The members of the Committee is not entitled to any bonus. To any reimbursement of expenses shall be within the limits of available resources to current legislation included in the estimates of the Ministry of Education, University and Research.

Article 8.
(Powers of the special regions and autonomous provinces).

1. They are subject to the powers of the special regions and autonomous provinces of Trento and Bolzano, in accordance with their statutes and their implementing rules and the requirements of Title V of Part II of the Constitution.
2. Within three months from the date of entry into force of this Act, the special statute regions and autonomous provinces of Trento and Bolzano shall implement the provisions of the law.

Article 9.
(clause financial invariance).

1. Subject with Article 4, paragraph 2, the implementation of this Act shall not derive new or increased burdens on public finances.

Blank Lease Addendum Template

Vaccines and misinformation on Social Networking: Who's fault?

Rome, September 29 (Reuters Health) - Vaccination in Italy today "are like the witches of a few centuries ago, which they said anything." And 'the bitter observation Cristella Daniel Jacques, president of the Group of Vaccines Farmindustria that during a workshop in Rome today released the results of a research on the perception of vaccination on social networks in Italy, conducted by Sanofi Pasteur MSD. A photograph from which the vaccines out pretty bad, only on Facebook - visit every day 8 million people - there are 40 000 groups and 1,200 pages on vaccines, in 95% of cases with a negative image. Things are not better on YouTube (visited by 7 million users per day): In March there were 10,000 movies on vaccines, with 10 new videos every day, in 90% of negative cases, or on MySpace (200 million of users per day and 2 000 pages on the subject, in 70% of cases with a negative image). A bit 'better on Twitter (though in Italy has only 100 thousand visitors a day): 70 000 pages on vaccines, only 20% with a negative image. In general, however, social networks (and research has examined the eight most common) seem to reject this means of prevention.

"This aversion to vaccination is something old - said Giovanni Rezza Department of Infectious Diseases National Institute of Health - just look at the 'cartoons' on the alleged effects of nineteenth-century anti-smallpox vaccine developed in 1796 by Edward Jenner. " Images unlikely that make you smile, "but the anti-vaccination can cause serious damage, as happened in the case of whooping cough in Britain in the '70s," said Rezza.
"We are all victims of poor communication on vaccines - complains Cristella - Missing the authority figure who knows everything, flower billion of opinion leaders on the web, where you can find information confused, old, reliable e non mescolate fra loro". Proprio per sfatare miti e leggende sui vaccini, è stato presentato alla stampa un documento con 30 domande e risposte in materia, che sarà rielaborato e integrato, per costituire un Libro Bianco sulle vaccinazioni. Dalle reazioni dell'organismo, al contenuto dei vaccini, ai prodotti in fase di sviluppo, ai controlli, fino alle strategie di ricerca, in 30 punti si analizzano "i temi che sono apparsi più spesso confusi sul web. E' importante invece fare chiarezza, perché - dice Cristelli - la confusione fa male a tutti". E se il caso dell'influenza A/H1N1 e della campagna vaccinale disertata da cittadini e operatori è ancora fresco, Cristelli ha tenuto a dire che "l'H1N1 non è stata una good step for the industry in terms of finances and image. "And you still will see that reflected the story on the upcoming seasonal influenza vaccination campaign. In short, there is still too much confusion on this issue, even among the same health workers. As revealed by the fact that, during the influenza pandemic, just 10-15% of Italian doctors and nurses has been vaccinated. "The battle will be long - provides Cristella - but it is important to ensure that people get a source of reliable information, real and shared. "

A summary of the contents of the important meeting held in Rome on September 29 entitled" Vaccines word of mouth what a mess "promoted by Confindutria seem important, why take note of what should be the methods of communication to be followed in 2010 for a correct and adequate information to citizens. outstanding problem at the moment and that concerns not only the modern systems of social network but also the more traditional information systems: the television and print media.
The basic question remains the same, however: by whom and how social networks take their information and why the information is often distorted or even contrary to the evidence? The interesting white paper can give adequate answers (we hope), but it would be very useful to reflect, discuss and admit errors committed in the course of vaccination campaigns or projects not implemented with sufficient strength, innovative strategy and method of communication or otherwise proposed by contradictory and wrong methods, based on epidemiological assumptions inaccurate to say the least (see "pandemic" to the 'H1N1)? How about some immunizations that are offered on the national territory patchy? What can be said in these cases, the social network?
The Department of Prevention of the Ministry of Health, the National Health Council, the State-Regions Conference, the National Institute of Health, the AIFA, the CCM are the six establishment figures who have a voice in the field of immunization. Usually working in harmony, but often have different opinions. The convergence of institutional sources is therefore already a step , perhaps by establishing systems and innovative methods of communication, even using, effectively, socialnetwork. The revolution, also cultural, could start from there. Think about it ... maybe not from the tail of the problem but from the head.

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flu vaccine at risk groups: recommendations for the 2010-2011 season

On 1 October, on the recommendation of the Ministry of Health, began the campaign for vaccination against l'influenza stagionale.
Dopo il clamore vissuto lo scorso anno per la famosa pandemia influenzale, l'impressione è che quest'anno (ancora una volta paradossalmente) se ne parli poco. Qualcuno dirà che questo è un bene, un segnale magari positivo per ricondurre le campagne di informazione, su argomenti di sanità pubblica, in una ambito formale che riguarda i medici, i distretti territoriali e magari le Regioni.
Tuttavia, il problema è quello di capire, come discusso recentemente anche su Medico e Bambino, quali strumenti di comunicazione vanno utilizzati per rendere, un programma di prevenzione di salute pubblica, davvero efficace. Ricordate Topo Gigio lo scorso anno che cercava in tutti i modi di tranquillizare l'opinione pubblica? E ci sarebbe riuscito magari benissimo se a distanza di due minuti dalle sue parole, magari nel notiziario sulla stessa rete televisiva, non ci fossero stati gli annunci sconsiderati e contraddittori di morti e di raccomandazioni che cambiavano di giorno in giorno.
Qualcuno dice che, a fronte di una possibile pandemia, era meglio fare tutto ed anche di più, e che i mass-media non potevano fare altre che riflettere queste contraddizioni.
Il richiamo a quanto è successo lo scorso anno e a quanto non accade in questi giorni sui principali organismi di stampa (ma anche sui siti di medicina e pediatria) ha tuttavia un obiettivo di richiamo al significato vero, epidemiologicamente serio, dell'influenza stagionale e della vaccinazione per prevent it.

In fact, the recommendations published by the Ministry of Health led back to the problem of the 2010-11 influenza prevention and control in an area now "scientific" absolutely reasonable with the identification of those at risk as the only place to go and the active offer of free vaccine: "The vaccination campaign vacation, promoted and financially supported by the National Health Service is mainly addressed to those identified and classified at risk of severe and sometimes lethal complications, in case from contracting the flu. The free offer is also aimed at active people at risk who are engaged in specific social value. The inclusion healthy children aged between 6 months and 24 months (or up to 5 years) in the priority categories to be immunized against seasonal influenza is a topic currently under discussion by the international scientific community. This choice has already been made by Canadian and American health care and some EU countries but the data of vaccination coverage achieved so far is insufficient to assess the impact of this intervention. Therefore it is not considered necessary to promote programs offering free activities of seasonal influenza vaccine to children who do not present individual risk factors. "

You can read the entire document, which also shows the measures demonstrably effective protective equipment, types of vaccines available and false contraindications to the use of the vaccine, on the home page of Medical and Child heading report.
October issue of The Physician and Child will be published a summary of the recommendations by the Institute of Health. Do not forget to read it. In the meantime, let's once again serving to make the flu shot this time very useful for children and adolescents at risk and therefore have sources really need.

seriously, and information science, without contradictions. Federico Marchetti