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Worldwide, lifestyle and resource disparities among adolescents contribute to unmet health needs, which have crucial present and future public health implications for both adolescents and broader communities. Risk of infection among adolescents is amplified by biological, behavioral, and environmental factors; however, infectious diseases to which adolescents are susceptible are often preventable with vaccines. Beyond these concerns, there is a lack of knowledge regarding adolescent vaccination and disease risk among parents and adolescents, which can contribute to low vaccine uptake. Promising efforts have been made to improve adolescent vaccination by programs with motivational drivers and comprehensive communication with the public. In May 2017, a multidisciplinary group of experts met in Amsterdam, Netherlands, to discuss adolescent vaccine uptake, as part of an educational initiative called the Advancing Adolescent Health Spring Forum. This article presents consensus opinions resulting from the meeting, which pertain to the burden of vaccine-preventable diseases among adolescents, reasons for low vaccine uptake, and common characteristics of successful strategies for improving adolescent vaccination.Conclusion: There is an urgent “call to action,” particularly targeting healthcare providers and public health authorities, for the prioritization of adolescent vaccination as a necessary element of preventive healthcare in this age group. What is Known:• Despite increased risk of certain infectious diseases, adolescent vaccination uptake remains low. What is New:• Barriers to adolescent vaccine uptake include lack of information regarding vaccines and disease risk, health system inadequacies, and insufficient healthcare follow-up.• Successful efforts to improve adolescent vaccine uptake need cohesive leadership and involvement of multiple stakeholders, as well as youth-friendly messaging; healthcare providers and policymakers should prioritize adolescent vaccination and implement proven program strategies to improve adolescent health worldwide.

To investigate possible impact of limited vaccine uptake by the private sector since 2007, a prospective observational study included all children

Aim: To evaluate the potential benefits of introducing universal rotavirus (RV) vaccination in Greece. Methods: A decision analytic model was developed to compare the burden and cost of rotavirus gastroenteritis (RVGE) with and without a universal RV vaccination (88% vaccination coverage) for a cohort of children followed from birth until the age of five. Results: Universal RV vaccination would substantially decrease the RVGE burden on the National Health System by reducing RVGE-related hospitalizations/emergency visits and medical consultations by 83% and 75%, respectively. Total RVGE-related costs was estimated at about 7.6 M€ and would be reduced by 5.9 M€ (−78%) if RV vaccination was introduced. A rapid effect is expected with 76% of cases and 84% of costs avoided would be averted within 2 years postvaccine introduction. The societal benefit would also be significant: total annual number of RVGE cases and parent’s lost work days would be reduced by 67% and 78%, respectively. Including indirect costs, the total disease cost reduction would be 9 M€. Conclusion: Introduction of universal RV vaccination in Greece could offer considerable medical and economic benefits for the National Health System and society. Potential herd immunity would improve results in favour of vaccination.

A national cross-sectional seroprevalence survey was conducted in order to evaluate the current seroepidemiology of hepatitis A among 1,383 children, aged 0-14 years, residing in Greece. Stratification of the study population was conducted according to age and area of residence. Sera from study participants were tested for the presence of anti-HAV IgG antibodies. Immigrant children, as well as children residing in rural areas, had lower immunization rates. Among unvaccinated children, the seroprevalence rate of anti-HAV was 17.1%. Nationality was shown to have a marginally significant effect since non-immunized immigrant children had a higher seroprevalence rate (22.4% vs. 15.9%, OR = 1.52, P = 0.064). Significant differences between geographic areas for both vaccination coverage and natural immunity were observed. The study findings indicate that hepatitis A is prevalent in Greece and therefore universal infant hepatitis A immunization should be implemented. J Med Virol

The present study describes the development, application and validation of the Α' TEST, a screening tool administered individually to kindergarten children to determine their school preparedness. The A' TEST evaluates six cognitive domains (abstract thinking, critical reasoning, language skills, visual perception, visual motor skills and organizational skills). It was administered to 2002 preschool children, and validated through comparison with well-established classification systems. Also, in order to examine the predictive value of the A' TEST, 201 of the examined children were reevaluated by their teachers two years after initial assessment. Analysis provided evidence of structure, convergent, concurrent and discriminant validity and reliability, as well as predictive validity. Overall, the Α' TEST predicted that 9.1% of the children were not school-ready, giving a 98.5% correct prediction when compared with the teachers' evaluations two years later. In conclusion, the Α' TEST is a valid and appropriate screening tool for school readiness.

Atopic dermatitis is a chronic inflammatory disorder of the skin, charachterised by a TH2 skewed cytokine profile, usually elevated total serum IgE and can be co coexpressed with other atopic clinical manifestations. The atopic skin is prone to bacterial colonization and that has an effect on immunological parameters. Atopic Dermatitis has been correlated with IgG hypoglobulinaemia, low serum IgA and downregulation of the CD8 lymphocytes in peripheral blood.

Background Although several determinants of global developmental delay (GDD) have been recognized, a significant number of children remain without definitive etiologic diagnosis. The objective of this study was to assess the effect of various prenatal and perinatal factors on the severity and outcome of developmental delay without definitive etiologic yield. Methods From March 2008 to February 2010, 142 children with developmental quotient (DQ) Results The mean age at enrolment was 31 ± 12 < months, and the mean DQ 52.2 ± 11.4. Prematurity and intrauterine growth restriction (IUGR) were found to be independently associated with lower DQ values. The mean DQ after the 2-year follow-up was 62.5 ± 12.7, and the DQ difference from the enrollment 10.4 ± 8.9 (median 10; range-10 to 42). DQ improvement (defined as a DQ difference?≥?median) was noted in 52.8% of the children. IUGR, low socio-economic status, and poor compliance to habilitation plan were found to be independently associated with poorer developmental outcomes. Conclusions Prematurity and IUGR were found to be significantly and independently related to the severity of GDD in cases without definitive etiologic yield. Poorer 2-year developmental outcome was associated with IUGR, low socioeconomic status and non compliance to habilitation plan. Prematurity was a significant determinant of the outcome only in association with the above mentioned factors.

U Zagrebu je 12. prosinca 2009. održan simpozij »Dijete u suvremenome hrvatskom društvu«, koji su organizirali Hrvatsko pedijatrijsko društvo, Hrvatska akademija znanosti i umjetnosti, Ministarstvo zdravstva i socijalne skrbi i UNICEF za Hrvatsku. Predavači su prikazali važne podatke o teškoćama kojima su izložena djeca u Hrvatskoj. Naime, nove bolesti, koje su u suvremenom svijetu sve češće u djece, zahtijevaju od svih koji su uključeni u zdravstvenu zaštitu djece nove pristupe radu, što podrazumijeva i dodatnu edukaciju. To nisu bolesti uobičajene u svakodnevnoj liječničkoj praksi. Pristup društva, zbog raznolikosti teškoća s kojima se djeca suočavaju, može biti samo multidisciplinaran. Temeljni nacionalni interes društva je usmjeriti više pozornosti i financijska sredstva na zdravstvenu zaštitu djece, jer to osigurava opstanak i zdravu budućnost društva. Taj pristup zahtijeva nacionalni konsenzus i jasnu političku odluku svih odgovornih službi., The symposium on the topic »Child in contemporary Croatian society«, organized by Croatian Pediatric Society, Croatian Academy of Sciences and Arts, Ministry of health and social welfare and UNICEF Croatia Office, was held in Zagreb on December 12, 2009. The lecturers have shown important information on difficulties the children in Croatia are exposed to. Namely, diseases of the so called »new morbidity«, which are becoming more and more frequent in the contemporary world, demand a new approach of work from all who participate in healthcare for children, including additional education. These diseases are not part of a practitioner’s routine activity. Due to variety of problems children are exposed to, the approach can be only multidisciplinary. Basic national interest of every country (basic interest of every human society) should be to direct more attention and financial resources to the healthcare of children, which would ensure the existence and healthy future of the society. This approach requires a national consensus and clear political decision of all responsible official services.

To evaluate the potential benefits of introducing universal rotavirus (RV) vaccination in Greece.A decision analytic model was developed to compare the burden and cost of rotavirus gastroenteritis (RVGE) with and without a universal RV vaccination (88% vaccination coverage) for a cohort of children followed from birth until the age of five.Universal RV vaccination would substantially decrease the RVGE burden on the National Health System by reducing RVGE-related hospitalizations/emergency visits and medical consultations by 83% and 75%, respectively. Total RVGE-related costs was estimated at about 7.6 M€ and would be reduced by 5.9 M€ (-78%) if RV vaccination was introduced. A rapid effect is expected with 76% of cases and 84% of costs avoided would be averted within 2 years postvaccine introduction. The societal benefit would also be significant: total annual number of RVGE cases and parent's lost work days would be reduced by 67% and 78%, respectively. Including indirect costs, the total disease cost reduction would be 9 M€.Introduction of universal RV vaccination in Greece could offer considerable medical and economic benefits for the National Health System and society. Potential herd immunity would improve results in favour of vaccination.

OBJECTIVE. Therapeutic delay has been suggested as the most important factor that is likely to have an effect on the development of scarring after acute pyelonephritis. However, this opinion has not been supported by prospective studies, so we tested it. METHODS. In a prospective clinical study, we evaluated whether the time interval between the onset of the renal infection and the start of therapy correlates with the development of acute inflammatory changes and the subsequent development of renal scars, documented by dimercaptosuccinic acid scintigraphy. A total of 278 infants (153 male and 125 female) aged 0.5 to 12.0 months with their first urinary tract infection were enrolled in the study. RESULTS. The median time between the onset of infection and the institution of therapy was 2 days (range: 1–8 days). Renal inflammatory changes were documented in 57% of the infants. Renal defects were recorded in 41% of the patients treated within the first 24 hours since the onset of fever versus 75% of those treated on day 4 and onward. Renal scarring was developed in 51% of the infants with an abnormal scan in the acute phase of infection. The frequency of scarring in infants treated early and in those whose treatment was delayed did not differ, suggesting that once acute pyelonephritis has occurred, ultimate renal scarring is independent of the timing of therapy. Acute inflammatory changes and subsequent scarring were more frequent in the presence of vesicoureteral reflux, especially that which is high grade. However, the difference was not significant, which suggests that renal damage may be independent of the presence of reflux. CONCLUSIONS. Early and appropriate treatment of urinary tract infection, especially during the first 24 hours after the onset of symptoms, diminishes the likelihood of renal involvement during the acute phase of the infection but does not prevent scar formation.

Objectives This study describes the epidemiology of rotavirus (RV) gastroenteritis (GE) disease following the introduction of RV vaccination in Greece in 2006. Design A prospective hospital-based surveillance. Setting A multicentre study was conducted at six hospitals in Greece between July 2008 and March 2010. The hospitals selected served 70% of the paediatric population in Greece. Participants Children aged

INTRODUCTION: Hepatitis A is a vaccine-preventable disease with epidemiology that has changed over the past decades. In Greece, the vaccine has been available and recommended, but no universal mass vaccination has been implemented as yet. OBJECTIVE: We sought to study the seroepidemiology of hepatitis A in Greek children. METHODS: The seroepidemiology of hepatitis A in children 0 to 14 years of age living in Greece was studied. We collected 100 sera per year of age, stratified by geographic region. Demographic data and documented hepatitis A vaccine history was entered into a specially designed anonymous database. Sera were tested for the presence of anti–hepatitis A virus immunoglobulin G antibodies (AxSYM, Abbott Laboratories, Hellas, Greece). RESULTS: Data from 948 children analyzed revealed that 40.7% of the children had received at least 1 dose of hepatitis A vaccine. To date we have examined 498 sera. Among fully vaccinated children who had received at least 2 doses of vaccine, 91.2% were immune. The overall prevalence of anti–hepatitis A virus antibodies in unvaccinated children was 15.4%. In unvaccinated children >12 months of age, the rate of natural immunity was 11.7% (33 of 282). Interestingly, neither age nor ethnicity were associated with higher rates of natural infection. Among unvaccinated infants, the rate of passively maternal antibodies was surprisingly high (15 of 30 [50%]), mainly because of children from immigrant or Gypsy families, reflecting maternal natural infection. CONCLUSIONS: The implementation of universal vaccination against hepatitis A in Greece should be discussed because, according to our results, 11.7% of unvaccinated children have serologic evidence of past natural infection.

INTRODUCTION: Children with symptomatic epilepsy have more learning difficulties (LDs) than those with idiopathic or cryptogenic epilepsies. However, there is little information on the prevalence of LDs in well-defined pediatric epileptic populations. OBJECTIVE: Our goal was to evaluate LDs in epileptic children. METHODS: We evaluated LDs in 37 epileptic children (18 boys and 19 girls; mean age: 8.29 ± 1.00 years) who had idiopathic generalized epilepsy (IGE) and were being treated with sodium-valproate monotherapy (22 with generalized tonic-clonic seizures and 15 with absence epilepsy). The mean duration of epilepsy and treatment was 3.48 ± 1.88 and 2.96 ± 1.80 years, respectively. All children attended mainstream schools, and their seizures were well controlled (without seizures for at least 6 months). We used the Athina Test for the Diagnosis of Learning Difficulties, a test that is partly based on the Illinois Test of Psycholinguistic Abilities, standardized in healthy Greek children. RESULTS: Children with IGE performed significantly poorer in all subtests except the auditory closure subtest (Table 1). No significant difference was found between the 2 subgroups. A negative correlation was found between disease duration and the score in auditory memory (r = −0.368; P = .025). CONCLUSIONS: Our results suggest an increased risk of LDs in children with IGE and well-controlled seizures. Early detection of the cognitive impact of IGE and subsequent intervention are needed to prevent educational underachievement. TABLE 1.Athina Test for the Diagnosis of LDsSubjects With Inadequate Performance, % P Children With IGEHealthy ChildrenAuditory memory64.99.0.000Visual memory43.29.0.000Grammatic closure43.29.0.000Auditory closure16.29.0.125Graphophonological awareness32.49.0.000Visual-motor coordination43.225.0.010

We present the results of a prospective multi-center, community-based epidemiological observational study regarding the clinical burden of pediatric rotavirus gastroenteritis (PRG) in Greece.

E P A T he European Paediatric Association (EPA) is pleased to announce a new partnership with The Journal of Pediatrics. We are proud to have established an affiliation with this prominent journal, which is published monthly by Elsevier. The Journal’s mission is: “Through a rigorous process of evaluation and peer review, The Journal of Pediatrics strives to publish pediatric research of the highest value for a diverse audience of pediatric healthcare professionals... The Journal seeks to inform immediate care decisions, deepen knowledge, and advance further scientific discovery to improve the quality of care and the health of infants, children, and adolescents” (http://www.jpeds.com/content/missionstatement). The latter part of the mission will be especially important for the practice-focused members of EPA because it harmonizes with EPA’s vision: “By 2015, [EPA will] be internationally perceived as the leading paediatric association in Europe and neighbouring areas, representing leading operative standards for uniting paediatricians internationally and facilitating their joint efforts to work, learn and grow together” (http://www.epa-unepsa.org/page/mission-objectives). In terms of quick access to medical updates, this new collaboration with The Journal will have a profound effect on our members by dramatically improving our membership’s access to new original research. Because The Journal publishes original clinical research articles, the clinical updates to members of EPA will now take an important step toward the research front, and thereby provide members of EPA with quicker access to premier quality pediatric research. This change indicates the start of a new important era for EPA. Making primary clinical research available to our members, of course, comes with a responsibility, and this is worth a comment. If and how to best use new research data clinically is a widely recognized challenge. Individual clinical trials do not necessarily reflect real-life clinical practice because patients cannot be stratified or randomized in clinical practice. The results of trials may or may not be applicable for the individual patient’s situation. We believe in our members’ ability to make clinical decisions if given access to new high-quality data. To date, that part has been missing. The research will, of course, remain important, and it will be even better covered from now on through the complementary educational functions of easily-digestible EPA newsletter features, scientifically robust

INTRODUCTION: Pediatric rotavirus gastroenteritis (PRG) is the most frequent cause of severe acute gastroenteritis (AGE) in children up to 5 years of age worldwide. OBJECTIVE: We sought to determine the proportion of PRG and compare its clinical burden to that of AGE caused by other pathogens. METHODS: The study was conducted in 4 hospital emergency units (HEUs) and 50 private pediatric clinics between January and May 2006. Children up to 5 years of age were included. A rapid stool immunochromatographic test for rotavirus antigen detection was performed. Symptom-severity scores were calculated by using the Clark scale. RESULTS: Seven hundred and six children participated in the study (median age: 20 months; 385 boys [54.5%]); 273 patients (38.6%) visited HEUs, and 433 (61.4%) visited private clinics. The proportion of PRG was 29% (95% confidence interval [CI]: 25.9%–32.6%) in the total study group, 18.3% (95% CI: 14.9%–22.3%) in private clinics, 45.7% (95% CI: 40.0%–51.7%) in HEUs, and 49.1% in hospitalized patients (95% CI: 42.3%–55.7%). Most children with PRG (71.7%) were between 6 months and 3 years old. Behavioral changes and signs of dehydration, weight loss, fever at ≥38°C, diarrhea, and vomiting were more prevalent with PRG (P < .01). In children with PRG, a higher incidence of moderate or severe gastroenteritis (P = .013 and .021, respectively), hospitalization (P = .011), and need for a clinical reevaluation (P = .012) was observed, as was longer hospitalization (5.14 ± 3.18 vs 3.69 ± 2.25 days; P = .039). CONCLUSIONS: PRG was responsible for nearly half the patients with AGE who visited HEUs or required hospitalization. Vaccination against rotavirus would help prevent this frequent and often severe disease.