Suvremeni hrvatski liberalizam

Research shows a high level of commitment to liberal-democratic values among leading Croatian politicians, without regard to whether they are from the party in power or the opposition. As a rule most show greater democratic disposition than one would assume based on parliamentary debates or government policies. There are numerous reasons, but one of the key reasons is that democratic values are always harder to bring to reality in countries at war. Although the war continues, there are signs of a strengthening liberal alternative to the nationalist party in power. In this paper, I identify a cleavage between elites whose primary orientation is toward the ethnonational revolution and those committed to a liberal-democratic, pluralist civil-society model for Croatia. I describe the convergent values of Croatian liberalism, and discuss possible alliances creating a viable liberal opposition in the next elections.Istraživanje ukazuje na visoku razinu prihvaćanja liberalno-demokratskih vrijednosti medu vodećim hrvatskim političarima, bez obzira pripadaju li stranci na vlasti ili oporbi. U pravilu, većina ih iskazuje veće demokratske dispozicije no što bi se očekivalo na temelju parlamentarnih debata ili političkih poteza. Postoje brojni razlozi za to, no jedan od ključnih jest da je demokratske vrijednosti uvijek teže ostvariti u zemljama u ratu. Premda se rat nastavlja, postoje znakovi jačanja liberalne alternative nacionalističkoj stranci na vlasti. Autor identificira rascjep između političkih elita sklonih etnonacionalističkoj transformaciji te onih sklonih liberalno-demokratskom, pluralističkom i civilnom modelu. Rad opisuje konvergentne vrijednosti hrvatskog liberalizma i razmatra pitanje mogućih koalicija koje bi stvorile liberalni blok na sljedećim izborima

How can secondary care-based clinicians access and use primary care-held vaccination data during a Paediatric Emergency Department attendance?

Background Before the SARS-CoV2/COVID pandemic, in the UK, coverage for some routine childhood vaccines e.g. MMR (measles, mumps, and rubella), were below global targets. A visit to hospital might provide an opportunity to offer a “catch-up” intervention to under-immunised children and young people, if clinicians could accurately identify them. Aims The overall aims were to look at sources of vaccination data available to clinicians working in the Paediatric Emergency Department (PED) and explore how an intervention might address under-vaccination. Methods A multiple methods pilot explored the feasibility and acceptability of delivering a brief public health intervention within a PED attendance. A scoping review summarised evidence for the delivery of interventions in hospitals to improve vaccination uptake in children and young people (CYP). Unmet vaccination need in under-fives was estimated via a cross-sectional observational study with a single data collection point for participants attending a large PED in Greater Manchester, in October 2021. Sources of vaccination data explored were: parent/carer recall, Child Health Information Services (CHIS), and Summary Care Records (SCRs). This was via a cross-sectional observational study (recall and SCRs) and a systems mapping approach (for CHIS). Results This work demonstrated that it was feasible and acceptable to deliver an intervention during a PED attendance and that vaccination interventions in hospital settings may be beneficial. There was considerable unmet need amongst children under the age of five years old, attending the PED, with extremely low levels of MMR coverage amongst those old enough to be eligible for two doses. Vaccination status was often over-estimated by parents/carers, CHIS were a definitive source of vaccination data but inaccessible to PED clinicians, and data within SCRs were presented in an inconsistent manner and often unstructured. Conclusion Whilst delivery of a vaccination-focused intervention during a PED attendance appears feasible, more work is needed to enable clinicians to identify those CYP with unmet vaccination need who might benefit from such an approach

Interventions delivered in secondary or tertiary medical care settings to improve routine vaccination uptake in children and young people. A scoping review protocol

Objective: The objective of this review is to identify and collate the available evidence, and to produce an overview of interventions delivered in secondary and tertiary healthcare settings with the aim of improving vaccination uptake in children and young people. Introduction: Vaccine hesitancy appears in the World Health Organization's Ten Threats to Global Health in 2019.1 Time spent in secondary or tertiary healthcare settings with a child or young person may present an opportunity to deliver vaccination-focused interventions. National Institute for Health and Care Excellence guidance highlights a gap in the evidence of the effectiveness of different interventions aimed at increasing immunization uptake among children and young people.2 Inclusion criteria: Quantitative studies that describe interventions delivered in secondary and tertiary care settings will be included. Participants will include children and young people aged less than 16 years and/or their parents/carers (potentially interventions could be delivered to the child-parent/carer dyad) present in a secondary or tertiary care setting as either a patient or relative. Methods: This scoping review will be conducted using MEDLINE, CINAHL, Cochrane Library, Embase, Web of Science, as well as gray literature. The scoping review will exclude publications not available in English and any publication older than 30 years. Two reviewers will independently select articles using the inclusion criteria, based on their title and abstract. Data will be extracted from selected full text articles using a data extraction tool based on JBI recommendations. Study findings will be presented in tabular form detailing the interventions identified in the literature

Vaping in children and young people (and why it’s a bad idea)

It is illegal for under-18s to buy vapes (e-cigarettes) in the UK, but evidence suggests that vaping amongst children and young people is a growing issue. Although recommended as a cessation aid for tobacco smoking in adults, the rationale for introduction of the Tobacco and Vapes Bill to “create a smokefree generation and tackle youth vaping” recognises the potential for harm caused by children and young people using vapes. Many vapes contain nicotine, and while the effects of nicotine from tobacco are well-established, much is unknown about the impacts of vaping-associated nicotine dependence. It is unlikely that vaping is entirely risk-free to health, particularly as nicotine is highly addictive. The wider context of how children and young people access vapes and why they use them also needs to be accounted for in identifying additional impact. Paediatricians need an awareness of prevention and cessation interventions, including how to start a supportive conversation around vaping and vaping cessation. The production and disposal of vapes also raises significant environmental concerns, so reducing vaping levels is also important for sustainability. Supporting children and young people to be nicotine free should be a public health priority

Facilitating GP registrations among children by linking with Child Health Information Services (CHIS)

Background Lack of access to primary care services, by not being registered with a general practitioner (GP), is a source of health inequality.1 Unregistered children are at risk of missing healthcare activity, including routine vaccination.2 NHS England has emphasised the importance of ensuring no child misses out on vaccination invitations and has sought to explore solutions for those not registered with a GP. NHS South, Central and West (SCW) currently provides Child Health Information Services (CHIS) coverage for 32% of the 0–19-year-old population in England.3 Approximately 1% (n=8000) of those aged 0–6 years within the areas covered are not registered with a GP. SCW CHIS maintains health records for all children aged 0–19 years who live in, attend school in, or are registered with a GP within one of its areas. CHIS is notified when a baby is born or moves into the area, when they register with a GP, and about their vaccinations and screening. The aim of this pilot was to facilitate GP registrations among children aged 0–6 years resident in Bath and North-East Somerset, Swindon, Wiltshire and Gloucestershire, so that families could access childhood vaccination and other healthcare services. Methods CHIS worked with NHS England South-West commissioners to develop a letter reminding parents/carers of the importance of registering their child with a GP. The letter was in plain English, written at a level below the average adult reading age, and included symbols to support accessibility. It outlined how to register, emphasising the process was quick, free and did not require a fixed address or identification. In September 2024, the letter was sent to the households of 807 children aged 8 weeks to 6 years who were not registered with a GP and had one or more missing routine vaccinations. A second letter was sent out the following month to all households where the child was under the age of 1 year (n=89). Results Within 2 months of the initial mailout, 77 children (9.5%) were newly registered with a GP in the area and 52 (6.4%) became up to date with their age-appropriate vaccinations.2 The cost of postage (the most expensive item at £0.86 per letter) for both mailouts (896 letters in total) was £770.56, which equates to just over £10 per new registration or just under £15 per child catching up with their vaccinations. Discussion and conclusion In recent years, there has been a rise in vaccine-preventable diseases such as measles, alongside widening health inequalities. It is therefore more important than ever that children are registered with a GP. CHIS providers are well positioned to identify non-registered cohorts and send simple and low-cost mailouts, resulting in increased registrations and an associated increase in uptake of routine childhood vaccination. Future work A planned project will expand the area covered and will look to identify indicators associated with uptake, for example, ethnicity, index of multiple deprivation. Related projects will look at the optimum number of reminders for vaccination appointments, moving to digital-first invitations and making reminders more accessible

Barriers to accessing pediatric health care : a focus on health equity in the UK

INTRODUCTION To achieve health equity, we must first understand health inequities. This article focuses on socioeconomic deprivation and associated barriers to accessing health care for children and their families in the UK, where, despite care being free at the point of delivery, economic barriers to health care access remain. METHODS Thematic analysis of findings from a large qualitative study with providers of secondary and tertiary pediatric care in the UK. Rapid research evaluation and appraisal lab methodology was used to analyze data and identify themes. RESULTS A total of 217 staff were consulted at all levels within 9 pediatric health care providers. Barriers to health care access were categorized under 2 intersectional themes: economic barriers and system accessibility. Examples of approaches to address barriers are presented and discussed. CONCLUSION Decision-makers, clinicians, and staff at all levels are encouraged to consider the accessibility of their services against the key themes identified in this study. To fully address equity, national policy is required to address system sensitivities and avoid unregulated approaches for certain groups/specialties widening the inequities they aim to address

Understanding responsibility for health inequalities in children’s hospitals in England : a qualitative study with hospital staff

Objectives This study aimed to understand how staff in children’s hospitals view their responsibility to reduce health inequalities for the children and young people who access their services. Design We conducted an exploratory qualitative study. Setting The study took place at nine children’s hospitals in England. Participants 217 members of staff contributed via interviews and focus groups conducted January–June 2023. Staff were represented at all levels of the organisations, and all staff who volunteered to contribute were included in the study. Analysis Data were analysed using Rapid Research Evaluation and Appraisal (RREAL) methodology for rapid assessment procedures (RAP). Results All of the children’s hospitals were taking some action to reduce health inequalities. Two key themes were identified. First, it was clear that reducing health inequalities was seen as something that was of vital import and should be part of staff’s day-to-day activity, framed as ‘everyone’s business.’ Many staff felt that there was an obligation to intervene to ensure that children and young people receiving hospital treatment were not further disadvantaged by, for example, food poverty. Second, however, the deeply entrenched and intersectional nature of health inequalities sometimes meant that these inequalities were complex to tackle, with no clear impetus to specific actions, and could be framed as ‘no-one’s responsibility’. Within a complex health and social care system, there were many potential actors who could take responsibility for reducing health inequalities, and staff often questioned whether it was the role of a children’s hospital to lead these initiatives. Conclusions Broadly speaking, senior leaders were clear about their organisational role in reducing health inequalities where they impacted on access and quality of care, but there was some uncertainty about the perceived boundaries of responsibility. This led to fragility in the sustainability of activity, and a lack of joined-up intervention. Most hospitals were forging ahead with activity, considering that it was more important to work to overcome health inequalities rather than debate whose job it was