The Role of Pediatricians in Providing Greater-Quality Care for Children: An Ongoing Debate

Child healthcare frequently is regarded as a secondary objective in the development of public health policies and not as a central issue. Cost-containment policies instead of quality of healthcare frequently have inspired strategic decisions in public health investments for pediatric structures and workforce. The negative implications of this decisional approach have been shown by the substantial unpreparedness of virtually all European health systems during the coronavirus disease 2019 (COVID-19) pandemic,5 particularly in the area of primary care. The debate on the negative effects of cost-containment policies in the area of primary care in not new. In recent years, the role of pediatricians within the several European healthcare systems was variously reformed by governments, with an eye more to the budget than to the quality of care and its structural components, including staffing adequacy, training, and consistency as well as facility environment and size.1 As a result, the number of general pediatricians in Europe has decreased during the past 20 years.Data from the World Health Organization show that the average number of general pediatricians per 100 000 population in Europe declined 30.1% from 26.5% in 1998 to 18.5% in 2013.A further reduction in the pediatric workforce was reported in 2018 by the European Paediatric Association, the Union of National European Paediatric Societies and Associations (EPA-UNEPSA). During the past 20 years, due to different factors, including socioeconomic and political reasons, several European countries decided to reform their public health systems and the responsibility of pediatric healthcare delivery was moved from pediatricians to general and family practitioners. The aim of this commentary by the Spanish Primary Care Pediatrics Association (AEPap), in collaboration with the European Confederation of Primary Care Pediatricians and EPA-UNEPSA, is to discuss data supporting the essential role played in Europe by well-trained pediatricians vs other providers in delivering quality healthcare for children

Interim 2017/18 influenza seasonal vaccine effectiveness: Combined results from five European studies

Between September 2017 and February 2018, influenza A(H1N1)pdm09, A(H3N2) and B viruses (mainly B/Yamagata, not included in 2017/18 trivalent vaccines) co-circulated in Europe. Interim results from five European studies indicate that, in all age groups, 2017/18 influenza vaccine effectiveness was 25 to 52% against any influenza, 55 to 68% against influenza A(H1N1)pdm09, -42 to 7% against influenza A(H3N2) and 36 to 54% against influenza B. 2017/18 influenza vaccine should be promoted where influenza still circulates

Differential clinical characteristics and prognosis of intraventricular conduction defects in patients with chronic heart failure

Intraventricular conduction defects (IVCDs) can impair prognosis of heart failure (HF), but their specific impact is not well established. This study aimed to analyse the clinical profile and outcomes of HF patients with LBBB, right bundle branch block (RBBB), left anterior fascicular block (LAFB), and no IVCDs. Clinical variables and outcomes after a median follow-up of 21 months were analysed in 1762 patients with chronic HF and LBBB (n = 532), RBBB (n = 134), LAFB (n = 154), and no IVCDs (n = 942). LBBB was associated with more marked LV dilation, depressed LVEF, and mitral valve regurgitation. Patients with RBBB presented overt signs of congestive HF and depressed right ventricular motion. The LAFB group presented intermediate clinical characteristics, and patients with no IVCDs were more often women with less enlarged left ventricles and less depressed LVEF. Death occurred in 332 patients (interannual mortality = 10.8%): cardiovascular in 257, extravascular in 61, and of unknown origin in 14 patients. Cardiac death occurred in 230 (pump failure in 171 and sudden death in 59). An adjusted Cox model showed higher risk of cardiac death and pump failure death in the LBBB and RBBB than in the LAFB and the no IVCD groups. LBBB and RBBB are associated with different clinical profiles and both are independent predictors of increased risk of cardiac death in patients with HF. A more favourable prognosis was observed in patients with LAFB and in those free of IVCDs. Further research in HF patients with RBBB is warranted

Total mercury in the night shark, Carcharhinus signatus in the western equatorial Atlantic Ocean

Mercury is the only element capable to biomagnificate along the food chain, and carnivorous fish tend to accumulate high concentrations of this element. Total mercury in muscle tissue of Carcharhinus signatus sampled along the western equatorial Atlantic Ocean was measured by atomic emission spectrophotometry with ICP/AES. The average total mercury concentrations were consistently greater than the maximum limit for human consumption established by the Brazilian Health Ministry for carnivorous fishes (1000 µg. kg-1 w.w.). Therefore, an average consumption of 0.1 kg/day of C. signatus would result in an average daily ingestion of 174.2 µg of Hg, more than five times the 30 µg/day intake established by the World Health Organization. In the range of lengths studied, body length could not be used as an indicator of the Hg contamination degree for C. signatus. Also, sex cannot be considered a determining factor in the total mercury accumulation in C. signatus.<br>O mercúrio (Hg) é o único metal que comprovadamente biomagnifica através da cadeia alimentar, e sendo assim, espécies de peixes predadores tendem a apresentar altas concentrações deste metal. Porções de tecido muscular de C. signatus coletados na região oeste equatorial do oceano Atlântico foram submetidas a extração ácida e tiveram a concentração de mercúrio determinada com acessório gerador de vapor a frio acoplado a um ICP-AES. A concentração média de Hg apresentou valores acima do limite máximo permissível para consumo humano estabelecido pela legislação brasileira (1000 µg.kg-1 de peso úmido). Conseqüentemente, um consumo médio de 0,1 kg.dia-1 de C. signatus resultaria numa ingestão media de 174,2 µg de Hg, mais de cinco vezes o consumo máximo de 30 µg.dia-1 estabelecido pela Organizacao Munidal da Saúde. Dentro das classes de tamanho analisadas, o comprimento total não pode ser utilizado como indicador do grau de contaminação por mercúrio em C. signatus. Ainda, o sexo não pode ser considerado um fator determinante na acumulação total de mercúrio em C. signatus