Health services for children in western Europe

Wolfe, Ingrid; Thompson, Matthew; Gill, Peter; Tamburlini, Giorgio; Blair, Mitch; Bruel, Ann Van den; Ehrich, J. H. H.; Pettoello-Mantovani, Massimo; Janson, Staffan; Karanikolos, Marina; McKee, Martin

doi:10.1016/s0140-6736(12)62085-6

Cited by 213 publications

(195 citation statements)

References 43 publications

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“…[3][4][5][6][7] However, awareness is growing that preventive services for children must be conducted more cost-efficiently and in better alignment with current health system issues, such as improved use of physician and nurse competence, evolving health priorities, inequities in health, and uneven access to preventive care. [8][9][10][11] Many countries have preventive child health care (PCH) programs for universal routine child health assessments, and vaccination programs. The Netherlands has a free PCH program for all children aged 0 to 18 years, including ∼17 routine health assessments.…”

Section: What This Study Addsmentioning

confidence: 99%

A Novel Triage Approach to Identifying Health Concerns

et al. 2016

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Section: What This Study Addsmentioning

confidence: 99%

A Novel Triage Approach to Identifying Health Concerns

et al. 2016

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“…147 The analysis of 'first contact models' in those countries with better child survival outcomes can provide useful insight into different ways of integrating healthcare across community and hospital boundaries. 141,148 The management of chronic childhood diseases such as asthma, diabetes, and epilepsy, requires a shift in focus from a hospital-centric model of provision to an integrated system that transcends arbitrary boundaries between primary and secondary care. Much might be lifted from the model of chronic care provision in the elderly with collaborative organisational arrangements between health and social services and supportive financial processes.…”

Section: Factors In Service Deliverymentioning

confidence: 99%

“…The Swedish model of multi-professional health centres with co-located primary care practitioners, paediatricians and other key allied health professionals, is an example of how integrated services may result in improved skills, efficiency and continuity of care for children with long term conditions. 141 Finally, the configuration of specialist services, and the model of care for those services is critical to improving patient outcomes (Table 3) with marked variation in extremely premature infant survival rate (52% to 85%.) demonstrated, despite adjustment for socio-demographic variables, significant differences between centres in antenatal and post-natal approaches to resuscitation and use of steroids.…”

Section: Factors In Service Deliverymentioning

confidence: 99%

Understanding why children die in high-income countries

et al. 2014

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Copyright and reuse:The Warwick Research Archive Portal (WRAP) makes this work of researchers of the University of Warwick available open access under the following conditions. Copyright © and all moral rights to the version of the paper presented here belong to the individual author(s) and/or other copyright owners. To the extent reasonable and practicable the material made available in WRAP has been checked for eligibility before being made available.Copies of full items can be used for personal research or study, educational, or not-forprofit purposes without prior permission or charge. Provided that the authors, title and full bibliographic details are credited, a hyperlink and/or URL is given for the original metadata page and the content is not changed in any way. AbstractThrough a structured narrative review of the literature, we have identified a wide range of factors influencing child and adolescent mortality in high income countries. These can be conceptualised within the four domains of intrinsic factors, the physical environment, the social environment, and service delivery factors. The most prominent factors in the literature are socio-economic gradients, although the mechanisms through which these gradients exert their effects are complex, affecting all four domains, and often poorly understood. While some factors are relatively fixed, including the child's gender, age, ethnicity and inherent genetic make-up, some parental characteristics, and some wider 3 environmental conditions, others may be amenable to interventions that could lessen risks and help to prevent future child deaths. A number of examples of systemic health service factors that may impact child survival are given, along with interventions such as modifications to the physical or social environmental that may impact more distal factors.

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“…Today, 22% of all deaths among children aged 1-14 years in Europe are due to cancer [1]. If this high proportion of cancer-related deaths is to be reduced, studies must be conducted not only on tumor biology and novel treatment approaches but also on how socioeconomic and social factors influence cure rates.…”

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confidence: 99%

Effect of socioeconomic position on survival after childhood cancer in Denmark

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Background One fifth of all deaths among children in Europe are accounted for by cancer. If this is to be reduced there is a need for studies on not only biology and treatment approaches but also on how social factors influence cure rates. We investigated how various socioeconomic characteristics were associated with survival after childhood cancer. Material and methods In a nationwide cohort of 3797 children diagnosed with cancer [hematological cancer, central nervous system (CNS) tumors, non-CNS solid tumors] before age 20 between 1990 and 2009 we identified parents and siblings and obtained individual level parental socioeconomic variables and vital status through 2012 by linkage to population-based registries. Hazard ratios (HR) and 95% confidence intervals (CI) for dying were estimated using multivariate Cox proportional hazard models. Results For all children with cancer combined, survival was slightly but not statistically significantly better the higher the education of the mother or the father, and with maternal income. Significantly better survival was observed when parents were living together compared to living alone and worse survival when the child had siblings compared to none. Young (<20) or older (40) maternal age showed nonsignificant associations, but based on small numbers. For hematological cancers, no significant associations were observed. For CNS tumors, better survival was seen with parents living together (HR 0.70, CI 0.51-0.97). For non-CNS solid tumors, survival was better with high education of the mother (HR 0.66, CI 0.44-0.99) compared to basic and worse for children with one (HR 1.45, CI 1.11-1.89) or two or more siblings (HR 1.29, CI 0.93-1.79) (p for trend 0.02) compared to none. Conclusion The impact of socioeconomic characteristics on childhood cancer survival, despite equal access to protocolled and free-of-charge treatment, warrants further and more direct studies of underlying mechanisms in order to target these as a means to improve survival rates.

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Health services for children in western Europe

Cited by 213 publications

References 43 publications

A Novel Triage Approach to Identifying Health Concerns

A Novel Triage Approach to Identifying Health Concerns

Understanding why children die in high-income countries

Effect of socioeconomic position on survival after childhood cancer in Denmark

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