UNION OF
NATIONAL
EUROPEAN PAEDIATRIC
SOCIETIES AND
ASSOCIATIONS
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Minutes of the UNEPSA General Assembly, Prague, June 15, 2002
The General Assembly of UNEPSA was called to order by President Jan Janda on June 15, 2002 at 8:45 to 13:30 hrs. A quorum was declared, with 15 voting National delegates present (see list of participants) and 4 members of the board of UNEPSA (Janda, Katz, Olah, Schmitz ).
Prof. Janda read greetings and letters from countries, which are not present in Prague. They support the further UNEPSA activities. Messages were received from Presidents of the following countries: Albania, Austria, Luxemburg, Macedonia, Norway, Poland, Portugal, Slovenia, Ukraine, United Kingdom. All members of UNEPSA had been invited to the meeting, nevertheless, some addresses changed do to new representatives and several countries did not answer at all.
The agenda was unanimously approved by the GA.
Jan Janda informed to
the General Assembly that according with the constitution one hour before
the
election, members have to suggest two members for 2 vacancies in the Board
(Secretary
General and treasurer).
The minutes of the General Assembly of 19th March, 2000 in Rome were unanimously approved by the GA . The amended constitution was unanimously approved by the GA.
President's report
The past (2000-2002)
Scientific activities of the board:
May 2002, pp. 788-796
The paper was presented by Manuel Katz and discussed.
Demography of Pediatric Primary Care in Europe: Delivery of Care
and
Training
Manuel Katz, MD*, Armido Rubino, MD , Jacqueline Collier, PhD , Joel
Rosen, BA||
and Jochen H. H. Ehrich, MD
Objective. The Union of National European Pediatric Societies and Associations recognized the lack of information regarding demography of delivery of care and training for the doctors who care for children in Europe. Therefore, the Union of National European Pediatric Societies and Associations studied factors and explanations for the variation between countries regarding pediatric primary care (PPC) and community pediatrics (CP) as well as the extent of formal training provided for those who take care of children at the community level.
Methods. An explanatory letter and a questionnaire with 12 questions regarding delivery of PPC and CP and training was mailed to the president of each of 41 national pediatric societies in Europe. Statistical data about population, country's income, and infant mortality rate (IMR) were also obtained from World Health Organization data. Statistical analysis using multivariate and linear regression was conducted to ascertain which variables were associated with IMR. Descriptive statistics regarding demography and training are also reported.
Results. In 1999, a total of 167 444 pediatricians served a population of 158 million children who were younger than 15 years and living in the 34 reporting European countries. The median number of children per pediatrician was 2094; this varied from 401 to 15 150. A pediatric system for PPC existed in 12 countries; 6 countries had a general practitioner system, and a combined system was reported from 16 countries. Pediatricians did not work at the primary care level at all in 3 countries. In 14 of 34 countries, pediatricians worked in various aspects of community medicine, such as developmental pediatrics, well-infant care, school physicians, and so forth. IMR was lower in countries with a higher income per capita. In addition, a pediatric system of primary care had a protective effect when looking at IMR as the outcome. In 75% of the countries, some form of training in pediatric care for pediatricians was reported; the corresponding data for general practitioners was 60%. Community-based teaching programs were offered to pediatricians and general practitioners in a minority of countries only.
Conclusions.
At the end of the century, Europe showed a considerable variation in both delivery of PPC and training for doctors who care for children. This study identified 3 different health care delivery systems for PPC, as well as 2 types of pediatricians who work in community-based settings. Formal training in PPC or CP for both pediatricians and general practitioners varied from established curricula to no teaching at all. Economic and sociopolitical issues, professional power, and geographical and historical factors may explain the differences in pediatric care among European countries.
2. Demography of renal care in Europe: A draft of a manuscript was presented by Jochen Ehrich and was discussed. The paper will be sent for publication to PEDIATRICS.
Demography of Pediatric Renal Care in Europe: Organization and
Delivery
of Care.
Jochen H.H.Ehrich, Anita Amina ElGendi, Alfred Drucker, Jan Janda,
Constantinos
Stefanidis, Kate Verrier-Jones, Jacqueline Collier, Manuel Katz
Objective. The European Society for Paediatric Nephrology (ESPN) recognized the lack of information available regarding demography of delivery of care and training for the doctors who care for children with kidney diseases in Europe. Therefore, ESPN stimulated it's members to study factors and explanations for the variation between countries regarding demography and policy of pediatric renal care.
Methods. An explanatory letter and a questionnaire with 16 questions regarding demography and policy of pediatric renal care was mailed to the president or secretary general of each of 43 national pediatric societies or working groups in Europe. Statistical data about population, country's income and Infant Mortality Rate (IMR) were obtained from W.H.O. data. Descriptive statistics were carried out including linear correlation, linear and multivariate regression in order to define predictive values; T-Test, ANOVA, Mann-Whitney-U-Test and Kruskal-Wallis-H-Test were used to compare means and medians.
Results. In 1998, 842 pediatric nephrologists worked in
42 European
countries with a median number of 9 pediatric nephrologists per country,
ranging
from 0 to 150. The median number of pediatric nephrologists per million
child
population was 4.9, with a range from 0 to 15. The mean number of children
per
pediatric nephrologist was significantly higher in countries with the
General
Practitioner Care System, namely 370,747 versus 169,456 in the Pediatric
Care
System, respectively 191,788 in the Combined Care System. In addition to
the
fully trained pediatric nephrologists there were 1087 pediatricians with a
part
time interest/activity in pediatric nephrology taking care of children
with
kidney diseases in 34 European countries. Eastern European countries had
significantly more of these pediatricians with nephrological activities
than
countries belonging to the EU (16.7 versus 6.6 pediatricians pmcp). The
mean
ratio of specialized pediatric nephrologists to all general pediatricians
was
significantly lower (1:276) in countries with the Pediatric Care System
than in
countries with the Combined (1:150) and the General Practitioner System
(1:147).
In 1998, 92% of all European countries offered
pediatric dialysis for acute
renal failure, 90% for chronic renal failure and 55% offered pediatric
transplantation. The availability of pediatric dialysis for ARF and CRF
was
significantly associated with the size of the child population. The
availability
of pediatric transplantation was also significantly associated with the
Gross
National Product, the geographical and political situation. Only 30% of
Eastern
and Central European countries offered pediatric transplantation versus
87% of
EU countries. The median number of hospitals offering dialysis for CRF was
1.5
ranging from 0 to 5.0 pmcp and the median number of pediatric hospitals
offering
renal transplantation pmcp was 0.4 ranging from 0 to 3.5 pmcp. Fewer
children
were dialyzed or transplanted in Eastern European countries than in the
European
Union. Eastern European countries provided more often a screening program
for
renal diseases in children. Seventy-one percent of all answering
pediatric
nephrologists stated that their country would need more pediatric
nephrologists
and 50% asked for more dialysis nurses.
Conclusions. At the end of the 20th century, Europe
showed a
considerable variation in delivery of pediatric renal care for children
with
kidney diseases. This study identified different types of pediatricians
working
in pediatric nephrology. In some Eastern European countries, dialysis
and
transplantation care for children were not in the hand of pediatric
nephrologists. Our data analysis indicates that differences throughout
Europe
concerning pediatric renal care are related to factors such as size of
the
population, geographical and political situation, the type of primary
pediatric
care system and the economic situation. The spectrum of pediatric renal
care
offered by pediatricians ranged from basic nephrology only to highly
specialized
renal replacement therapy. This may explain the unexpected result of
almost
equal numbers of doctors caring for children with kidney diseases in
Eastern
Europe and in Western European countries. The goal number for
specialized
pediatric nephrology centers per country is estimated to be in the order
of
approximately 1.2 to 1.6 centers pmcp having a minimum of four pediatric
nephrologists per center who can provide a 24 hours service.
According to our data there seem to be enough pediatric
nephrologists both in
Western and Eastern European countries in order to meet the demands of a
high
standard of renal care. In countries with a small child population
co-operation
with local adult nephrologists or with pediatric nephrologists from
neighboring
countries remains an effective alternative to specialized national
pediatric
nephrology centers.
Europe at the end of the 20th century is far from equal
access to renal
replacement therapy for children. Concerning dialysis for ARF or CRF the
question is not anymore the pure availability but the extent of
availability.
According to our data about 90% of European countries provided pediatric
dialysis for CRF in 1998 but only 55% pediatric renal transplantation
which is
unsound considering the clinical and financial long term superiority of
renal
transplantation. The challenge is therefore to identify the reasons for
the low
transplantation rate and to overcome this paradoxical
situation.
The importance of registered data on children with
renal replacement therapy in
order to define the costs of pediatric renal care is self-explanatory.
However,
only 50% of countries of Eastern Europe were reporting to a registry. In
these
days of globalization, co-operation is one of the basic conditions in
order to
promote equity in health care. In fact the lack of scientific
co-operation
during the Cold War can be made responsible for discrepancies
encountered
throughout Europe concerning the quantity and the quality in health
services.
Co-operation consisting of solidarity and scientific collaboration will
therefore also play an important role in the context of European pediatric
renal
care today in order to provide equity of care for all children.
3. Financial report: Jochen Ehrich reported about the UNEPSA finances
In April 1998 the UNEPSA account balance was 0 DM In March 2000 12,501.18 DM By the end of 2001 19,060 DM
Jochen Ehrich emphasized that there is a positive change in finances
of
UNEPSA, however, UNEPSA continues to have a serious problem in collecting
the
money from different countries. As an example only 4 countries already
paid
their dues in 2001 (Israel, Spaqin, Turkey and Norway) and 5 countries did
so in
2000 (Norway, Czech Republic, Spain,Germany, Turkey).
Manuel Katz suggested a new initiative to collect dues
based on country income
per capita, and number of pediatricians. According to this proposal
countries
will pay 800, 500, 300 or 100 Euro per year. It was suggested that UNEPSA
will
need at least 10,000 Euro per year in order to accomplish part of the
goals.
The General Assembly voted unanimously that the delegates don't have the
mandate
to decide about the proposition and that it has to be approved by each
country
individually. Manuel Katz will send by mail to each representative the
proposed
dues payment to be approved by each country. The dues payment system was
sproposed: 800 Euro: Austria, Belgium, France, Italy, Spain,
Netherlands,
Sweeden, Turkey, United Kingdom Germany, Norway, Switzerland, 500 Euro:
Denmark,
Finland, Israel, Portugal, Czech Republic, Greece, Hungary, Poland 300
Euro:
Ireland, Luxemburg, Slovakia, Croatia, Slovenia, Russia, 100 Euro:
Bulgaria,
Cyprus, Estonia, Latvia, Macedonia, Ukraine, Lithuania, Roumania,
Jacques
Schmitz suggested that the same type of calculation may be used by
IPA.
4. Europaediatrics 2003
Manuel Katz (President of Europaediatrics) and David
Branski (Co-Chairman of the Scientific and Organising Committees reported
about
the congress.
See enclosed powerpoint presentation (venue, hotels,
program,
suggested topics, etc.)
Manuel Katz asked the members of the GA participant to
be supportive and active in stimulating the participation of
paediatricians.
EUROPAEDIATRICS 2003 should be adverstised during National Congresses.
He
reported about the possibility to have 200 Mexican paediatricians in the
congress. Andria Generoso proposed to publish the information troughout
the
official journals and national paediatric newspapers.
It was suggested to share
with the organising company the mailing list from paediatricians in order
to
spread the information as widley as possible.
5. The Unepsa Website
Jan Janda and Jan Vejvalka reported about the UNESA website www.unepsa.org This was developed during the last 6 months having link to the major international paediatric sites, the Europaediatrics 2003 and all the information about UNEPSA (constitution, aims, etc).
6. Further mission of UNEPSA
The possibilty was dicussed again to have the Europediatric Society, suggested by Ehrich and Katz in 1998. The idea is to have an umbrella society bringing all the European Paediatric organisations together. Jacques Schmitz suggested to have a meeting in this matter in Paris very soon and discuss this proposal
7. Election of two members
Manuel Katz informed to the General Assembly that Jochen Ehrich and Manuel Katz have finished their 6 years mandate at the UNEPSA council and should to be replaced. According with the constitution a quorum of 2/3 of the members was needed for council election. Unfortuantely the number of participating members was less than permitted. Jaques Schmitz suggested to allow Katz and Ehrich to stay ex officio until the next General Assembly in October 2003 in Prague during the Europaediatrics 2003. The proposition was approved unanimously.
| Jan
Janda President |
Dr. Manuel Katz |
Proposal for the UNEPSA
web
site and UNEPSA Newsletters (later v.s. EPA web site) | UNEPSA (EPA) missions
and
aims | Contacts,
UNEPSA Council |
Constitution of
UNEPSA | Draft of
EPA
(European Paediatric Association) | National Paediatric
Societies in
Europe | Paediatric
Subspeciality Societies |
Demography of Paediatric
Primary
Care (PPC) in Europe