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The Union of National European Pediatric Societies and Associations (UNEPSA) held a symposium in 1997 in Warsaw, Poland, on pediatric primary care (PPC) and community pediatrics (CP). The presidents of [...], 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. Pediatrics 2002;109:788-796; primary care, ambulatory pediatrics, delivery of care, training in primary care, European pediatrics.

Oral administration of immunoglobulin may be effective in the treatment of acute rotaviral gastroenteritis in children. Rotavirus infection is the most frequent cause of gastroenteritis, resulting in severe diarrhea. The only therapy to date is oral rehydration. A total of 71 children with acute rotavirus gastroenteritis were divided into two groups. Group A received a single oral dose of 300 milligrams per kilogram of body weight of immunoglobulin and group B received a single oral dose of a glucose solution. After receiving treatment, children in group A had faster recoveries than those in group B. A significant reduction in bowel movements was observed in group A during the four days after therapy compared to group B. Apparently, immunoglobulin reduced the duration of diarrhea in group A. No side effects were noted during the study. Physicians should use immunoglobulin therapy to treat children hospitalized with acute rotaviral gastroenteritis., ABSTRACT. Objective. Preliminary evidence has been reported on the antirotavirus effect of human serum immunoglobulin administered orally. The aim was to see whether such treatment might be effective in rotavirus acute gastroenteritis. Methods. A prospective, double-blind, placebo-controlled study was performed. Ninety-eight children admitted with acute gastroenteritis were enrolled and randomly assigned to groups A (treated) and B (control). Children in group A received a single oral dose of 300 mg/kg body weight of human serum immunoglobulin. Parameters of efficacy were clinical condition, frequency and consistency of stools, duration of diarrhea, duration of viral excretion, and length of hospital stay. Antirotaviral activity was determined in the immunoglobulin preparation by a specific neutralization assay. Results. Seventy-one of the 98 children enrolled had rotaviral gastroenteritis; 36 belonged to group A. Children who received immunoglobulin had significantly faster clinical improvement of clinical condition and stool pattern than control children. Mean total duration of rotaviral diarrhea was 76 hours in group A and 131 in group B (P < .01). Viral excretion lasted 114 and 180 hours, respectively (P< .01). Hospital stay was significantly reduced in children in group A. Neutralizing antibodies against rotavirus were detected in the immunoglobulin preparation. Conclusion. Oral administration of immunoglobulin is associated with a faster recovery from acute gastroenteritis and should be given to children hospitalized with this illness. Pediatrics 1994;93:12-16; immunoglobulin, gastroenteritis, rotavirus, diarrhea.