Europaediatrics takes place every 2 years, this flagship event of EPA-UNEPSA (European Paediatric Association, the Union of National European Paediatric Societies and Associations) is the meeting point of general pediatricians and pediatric subspecialists, not only from Europe but from all over the world. The scientific program of Europaediatrics 2015 is being developed in close collaboration with several major European Pediatric Specialty societies

European health care systems need to adapt to ongoing financial pressures, while at the same time evolving better to suit changing health care needs of children as chronic conditions become increasingly dominant problems.2 For example, in response to current global economic pressures, many countries are considering changing from a pediatriciandelivered primary care system to a general practitioner model as a cost-cutting exercise, rather than in response to evidence about quality. Different possible “extreme scenarios” have been described1 in response to the likelihood that substantial changes in health care will unfold for European healthcare in the next 20 years. Three of these scenarios include: (1) European nations joining forces to create a single pan-European healthcare system; (2) preventive medicine taking precedence over acute care for sick patients; and (3) European healthcare systems focusing on vulnerable members of society. These scenarios are proposed and analyzed in this article by the strategic pediatric alliance for the future health of children in Europe consortium (SPA)

European health care systems need to adapt to ongoing financial pressures, while at the same time evolving better to suit changing health care needs of children as chronic conditions become increasingly dominant problems.2 For example, in response to current global economic pressures, many countries are considering changing from a pediatriciandelivered primary care system to a general practitioner model as a cost-cutting exercise, rather than in response to evidence about quality. Different possible “extreme scenarios” have been described1 in response to the likelihood that substantial changes in health care will unfold for European healthcare in the next 20 years. Three of these scenarios include: (1) European nations joining forces to create a single pan-European healthcare system; (2) preventive medicine taking precedence over acute care for sick patients; and (3) European healthcare systems focusing on vulnerable members of society. These scenarios are proposed and analyzed in this article by the strategic pediatric alliance for the future health of children in Europe consortium (SPA)

Caso Clinico: colestasi e scarso accrescimento come sintomi indicativi di sindrome comoplessa

Designing children’s hospitals requires new solutions for the re-organization of services, and renovating, merging, or closing old hospitals, as well as building new children’s hospitals. This article is the first of a 3-report series opening the debate on the future of children’s hospitals in Europe. Children’s hospitals should be child friendly and safe, thus creating a “small world in itself.” They must communicate with the outside world and offer a comprehensive expertise to the regional territory. Large children’s hospital should provide specialist tertiary and quaternary services for children, including highly specialized equipment and access to rare procedures and clinical trials that may involve experimental treatments and procedures. Furthermore, each specialist unit should provide outreach clinics in regional centers, bringing their expertise closer to the patient, and also should be able to engage in shared care arrangements with local pediatricians working in regional pediatric units. It is conceivable that such hospital model, proposing high quality standards of safe and reliable care for all children, would become progressively the preferred alternative to standalone children’s hospitals and mother and child centers. These centers may become less relevant to the population and therefore less likely to maintain any political support that may have favored their survival throughout the years, despite a likely substantial inefficiency

Mismanaged protein trafficking by the proteostasis network contributes to several conformational diseases, including cystic fibrosis, the most frequent lethal inherited disease in Caucasians. Proteostasis regulators, as cystamine, enable the beneficial action of cystic fibrosis transmembrane conductance regulator (CFTR) potentiators in ΔF508-CFTR airways beyond drug washout. Here we tested the hypothesis that functional CFTR protein can sustain its own plasma membrane (PM) stability. Depletion or inhibition of wild-type CFTR present in bronchial epithelial cells reduced the availability of the small GTPase Rab5 by causing Rab5 sequestration within the detergent-insoluble protein fraction together with its accumulation in aggresomes. CFTR depletion decreased the recruitment of the Rab5 effector early endosome antigen 1 to endosomes, thus reducing the local generation of phosphatidylinositol-3-phosphate. This diverts recycling of surface proteins, including transferrin receptor and CFTR itself. Inhibiting CFTR function also resulted in its ubiquitination and interaction with SQSTM1/p62 at the PM, favoring its disposal. Addition of cystamine prevented the recycling defect of CFTR by enhancing BECN1 expression and reducing SQSTM1 accumulation. Our results unravel an unexpected link between CFTR protein and function, the latter regulating the levels of CFTR surface expression in a positive feed-forward loop, and highlight CFTR as a pivot of proteostasis in bronchial epithelial cells.

The profound diversities among the EU28 postgraduate pediatric programs have been analyzed in this study. In general they are attributable to a multiplicity of factors, which are descrtibed in the paper. The original data included in the article show how the postgraduate pediatric training is currently (2014) performed in the EU28 nations. The 28 different national programs last from 4 to 8 years and present strikingly diversities. We have arbitrarily divided the nations into two groups: Group A includes nations that offer a 4-year basic course in general pediatrics and in some cases an additional 1-3 years optional training in selected pediatric subspecialties, and Group B includes nations that offer a 5- to 8-year basic course in pediatrics, including general pediatrics and part of pediatric subspecialties, which in some cases may be further expanded by 1-3 years of specific subspecialty training. The educational system in the Group B nations is intended to ensure that primary care pediatricians are prepared for the diversity of clinical and social problems that they will encounter and that specialist pediatricians receive sufficient training in rare and complex disorders. In conclusion, the evidence of a profound diversity of postgraduate pediatric training programs among the EU28 should be carefully considered and addressed, as a propaedeutic approach to ensure the appropriateness and feasibility of any QA and QI assessment program and ultimately to ensure a satisfactory and appropriate level of pediatric health care for European children in future decades.

Objective To evaluate differences in child health care service delivery in Europe based on comparisons across health care systems active in European nations. Study design A survey involved experts in child health care of 40 national pediatric societies belonging both to European Union and non-European Union member countries. The study investigated which type of health care provider cared for children in 3 different age groups and the pediatric training and education of this workforce. Results In 24 of 36 countries 70%-100% of children (0-5 years) were cared for by primary care pediatricians. In 12 of 36 of countries, general practitioners (GPs) provided health care to more than 60% of young children. The median percentage of children receiving primary health care by pediatricians was 80% in age group 0-5 years, 50% in age group 6-11, and 25% in children >11 years of age. Postgraduate training in pediatrics ranged from 2 to 6 years. A special primary pediatric care track during general training was offered in 52% of the countries. One-quarter (9/40) of the countries reported a steady state of the numbers of pediatricians, and in one-quarter (11/40) the number of pediatricians was increasing; one-half (20/40) of the countries reported a decreasing number of pediatricians, mostly in those where public health was changing from pediatric to GP systems for primary care. Conclusions An assessment on the variations in workforce and pediatric training systems is needed in all European nations, using the best possible evidence to determine the ideal skill mix between pediatricians and GPs.

Background: To assess the prevalence of femicides in Italy over the last three years and the potential long lasting effects of these traumatic events for the children of a woman who dies a violent death. Methods: The data used in this study come from an internet search for the number of femicides occurring in Italy between 1st January, 2012 and 31st October, 2014. Results: The total number of femicides was 319; the average age of murdered women was 47.50 ± 19.26. Cold arms in the form of sharp object -mostly knives- have caused the death of 102/319 women; firearms were used in 87/319 cases; asphyxiation was the chosen method in 52/319 cases. About the place where the femicides occurred, 209/319 were committed inside the victim’s house. Children of women who died a violent death were 417 with a total of 180 minors in less than three years. A total of 52/417 children were witness to the killing and, among these 30/52 were minors; in 18/417 cases, children were murdered together with their mother and among these 9/18 were minors. Conclusions: Long-term studies are needed to ascertain what happens to these children, to understand what are the most appropriate psychological treatments, the best decisions about the contact with their father and the best placement for these children.

Children living in foster care belong to a vulnerable child population that is afflicted by a wide range of acute and chronic psychosocial, mental, and even physical health conditions requiring multidisciplinary care services. Because of the complexity of their nature, such care services must be specific and cannot simply be integrated into standard services of the general pediatric population. The organizational profile of services for vulnerable children should include special healthcare assistance provided by specialized personnel. The combination of psychosocial, medical, and educational care usually leads to immediate and long-term extra cost, which may pay out only decades later. This social and economic investment may be regarded by economists as being hardly affordable, especially during recession periods. However, there are alternatives allowing adequate care even in times of economic turmoil.The aim of the report is to raise the awareness of the pediatric community and the public opinion toward the importance of investing in health programs offering adequate protection, prevention, and provision of care for orphan, abandoned, maltreated, and neglected children.

BACKGROUND: Congenital tufting enteropathy (CTE), an inherited autosomal recessive rare disease, is a severe diarrhea of infancy which is clinically characterized by absence of infl ammation and presence of intestinal villous atrophy. Mutations in the EpCAM gene were identified to cause CTE. Recent cases of syndromic tufting enteropathy harboring the SPINT2 (19q13.2) mutation were described. METHODS: Four CTE Italian patients were clinically and immunohistochemically characterized. Direct DNA sequencing of EpCAM and SPINT2 genes was performed. RESULTS: All patients were of Italian origin. Three different mutations were detected (p.Asp219Metfs*15, Tyr186Phefs*6 and p.Ile146Asn) in the EpCAM gene; one of them is novel (p.Ile146Asn). Two patients (P1 and P2) showed compound heterozygosity revealing two mutations in separate alleles. A third patient (P3) was heterozygous for only one novel EpCAM missense mutation (p.Ile146Asn). In a syndromic patient (P4), no deleterious EpCAM mutation was found. Additional SPINT2 mutational analysis was performed. P4 showed a homozygous SPINT2 mutation (p.Y163C). No SPINT2 mutation was found in P3. CLDN7 was also evaluated as a candidate gene by mutational screening in P3 but no mutation was identifi ed. CONCLUSIONS: This study presented a molecular characterization of CTE Italian patients, and identified three mutations in the EpCAM gene and one in the SPINT2 gene. One of EpCAM mutations was novel, therefore increasing the mutational spectrum of allelic variants of the EpCAM gene. Molecular analysis of the SPINT2 gene also allowed us to identify a SPINT2 substitution mutation (c.488A>G) recently

Western European health systems are not keeping pace with changes in child health needs. Non-communicable diseases are increasingly common causes of childhood illness and death. Countries are responding to hanging needs by adapting child health services in diff erent ways and useful insights can be gained through comparison, especially because some have better outcomes, or have made more progress, than others. Although overall child health has improved throughout Europe, wide inequities remain. Health services and social and cultural determinants contribute to differences in health outcomes. Improvement of child health and reduction of sufferring are achievable goals. Development of systems more responsive to evolving child health needs is likely to necessitate reconfiguring of health services as part of a whole-systems approach to improvement of health. Chronic care services and first-contact care systems are important aspects. The Swedish and Dutch experiences of development of integrated systems emphasise the importance of supportive policies backed by adequate funding. France, the UK, Italy, and Germany off er further insights into chronic care services in diff erent health systems. First-contact care models and the outcomes they deliver are highly variable. Comparisons between systems are challenging. Important issues emerging include the organisation of fi rst-contact models, professional training, arrangements for provision of out-of-hours services, and task-sharing between doctors and nurses. Flexible fi rst-contact models in which child health professionals work closely together could off er a way to balance the need to provide expertise with ready access. Strategies to improve child health and health services in Europe necessitate a whole-systems approach in three interdependent systems—practice (chronic care models, fi rst-contact care, competency standards for child health professionals), plans (child health indicator sets, reliable systems for capture and analysis of data, scale-up of child health research, anticipation of future child health needs), and policy (translation of high-level goals into actionable policies, open and transparent accountability structures, political commitment to delivery of improvements in child health and equity throughout Europe).

Durante gli ultimi cinquant’anni si è determinato un profondo mutamento nella gestione del bambino ospedalizzato sia per brevi che per lunghi periodi. L’ “umanizzazione delle cure”, ovvero del trattamento dei bambini in ospedale, ha costituito infatti durante i recenti anni una seria preoccupazione per la società civile, ed uno dei principali obiettivi dei centri di cura pubblici e privati, degli operatori della sanità e della componente politica e legislativa. Ad esempio, il progetto "Arte, lettura e gioco in corsia" curato nel 2012 dal gruppo di ricerca del “Laboratorio di Ricerca e Studio per l'Infanzia” del Dipartimento degli Studi Umanistici dell’Università degli Studi di Foggia, rappresenta un ottimo modello di tale sensibilità sociale e della positiva integrazione operativa professionale multidisciplinare rivolta al bambino. Infatti, il progetto ben si integra con la nozione di Family Centered e Family Oriented Care in Pediatria che si è sviluppata ed ha guidato la gestione delle cure pediatriche nel secondo dopoguerra, arrivando ad affermarsi e consolidarsi progressivamente sino ai nostri giorni. Comprendere bene lo sviluppo e l’essenza di queste nozioni è di fondamentale importanza sia per poter inquadrare adeguatamente la molteplicità di interventi di alta valenza qualitativa sviluppatisi in relazione al bambino ospedalizzato, come nel caso del progetto interattivo “Arte, lettura e gioco in corsia”, che per poterne comprendere compiutamente l’impatto sul il miglioramento delle cure ed della ospedalizzazione pediatrica. Questo capitolo desidera valorizzare l’importanza di un miglioramento della “comunicazione” con i bambini, gli adolescenti e le loro famiglie, come fattore di ottimizzazione della pratica medica rivolta ai soggetti in età evolutiva, in particolare se ospedalizzati.

Background: Serious concern has been raised about the sustainability of public health care systems of European Nations and ultimately about the health of European citizens, as a result of the economic crisis that has distressed Europe since 2008. The severe economic crisis of the Euro zone, which is still afflicting Europe in 2016, has in fact threatened to equally impact public health services of nations presenting either a weak or a strong domestic growth. Comments: On behalf of the European Paediatric Association, the Union of National European Societies and Associations, the authors of the Commentary debates the relationship between the effects of economic instability and health, through the report on an article recently published in the Italian Journal of Pediatrics, which emphasized the importance of integrating existing public health care services, otherwise independently provided by public hospitals, and Primary Care Paediatric networks. The interconnections between the effects of economic instability and health are briefly commented, following the observation that these two factors are not yet fully understood, and that the definition of proper solutions to be applied in circumstances, where health is negatively impacted by periods of economic distress, is still open for discussion. Furthermore it is noted that the pressure to “deliver more for less” often seems to be the driving force forging the political strategic decisions in the area of pediatric healthcare, rather than social, cultural, and economic sensitivity and competences. Thus, the delivery of appropriate pediatric healthcare seems not to be related exclusively to motivations aimed to the benefit of children, but more often to other intervening factors, including economic, and political rationales. Conclusions: The conclusions emphasize that local European experiences suggest that positive and cost effective healthcare programs are possible, and they could serve as a model in the development of effective cross-border regional program, not weakening the quality of services provided to children.

Expert specialist care is essential for the diagnosis of rare conditions and for children who require complex investigations and highly technical interventions, such as transplantation. This intensive specialist care often requires deep collaboration between a number of specialists to ensure optimal outcomes. Generally, how this specialist care is planned, organized, funded, and assured has not been fully researched, thus, the result is a huge diversity of provision across Europe. Less well-resourced countries in Eastern Europe face the dilemma of how best to develop specialist care in the future, better resourced countries in Western Europe face the problem of how best to rationalize and co-locate interdependent specialist services to improve outcomes, and small countries must find ways of developing effective cross-border care. Large centers with multiple specialists often are recommended as the best way forward, but this strategy also risks fragmentation and potentially undermines the competence within local hospitals, as well as being inconvenient for families living far away. The Article describes the nature of specialist care, the training of specialists, and the interdependencies between specialist teams and propose networked solutions to overcome some of the concerns, such as the increasing gap between primary and tertiary care.

According to the World Health Organization, “rehabilitation [of people with disabilities] is a process aimed at enabling them to reach and maintain their optimal physical, sensory, intellectual, psychological and social functional levels. Rehabilitation provides disabled people with the tools they need to attain independence and self-determination.” The World Health Organization’s Website illustrates this definition with a photo showing a child in a wheelchair; however, the spectrum of rehabilitation goes far beyond neurologic disabilities and includes virtually all organ systems with or without neurologic comorbidities. Unfortunately, these other indications for rehabilitative care are sparsely mentioned in the relevant literature dealing with rehabilitation of children. The article discusses such issues and the current status of this are of child health care in Europe, emphasizing that the tradition and degree of pediatric rehabilitation vary widely. Although some countries, such as Germany, have widely adopted trends of the 1980s to establish pediatric rehabilitation as an separate field or even discipline,other countries have not felt the need to do so, and consider rehabilitation a responsibility of hospitals or other already existing health care providers. These factors are also discussed in the article.

The article focuses on the participation of children in pediatric care, which means that the child’s voice must be heard and opinion respected. It is the responsibility of duty-bearers (eg, physicians, nurses, parents) to ensure the rights of rights-holders (children) are fulfilled. Participation is based on a positive mental attitude of all people involved, and should improve all aspects of health care delivery. If successful, it should generate a new culture of authentic partnership between all involved—including children and adolescents—whose views are required to improve hospital structure and function, as well as processes of medical care, systems development, the generation of health policy, medical education, and research. Participation of children and adolescents in pediatrics also includes developing new strategies for preventing illnesses by addressing risk-taking behaviors and positive health determinants, not only in vulnerable populations but by understanding and addressing the existential vulnerability of all young people. Developing these concepts together with young people to: (1) improve quality of health care; (2) design pathways for translating evidence into practice; and (3) monitor and evaluate patient safety will require focused participatory activities.

Restoration of BECN1/Beclin 1-dependent autophagy and depletion of SQSTM1/p62 by genetic manipulation or autophagy-stimulatory proteostasis regulators, such as cystamine, have positive effects on mouse models of human cystic fibrosis (CF). These measures rescue the functional expression of the most frequent pathogenic CFTR mutant, F508del, at the respiratory epithelial surface and reduce lung inflammation in Cftr(F508del) homozygous mice. Cysteamine, the reduced form of cystamine, is an FDA-approved drug. Here, we report that oral treatment with cysteamine greatly reduces the mortality rate and improves the phenotype of newborn mice bearing the F508del-CFTR mutation. Cysteamine was also able to increase the plasma membrane expression of the F508del-CFTR protein in nasal epithelial cells from F508del homozygous CF patients, and these effects persisted for 24 h after cysteamine withdrawal. Importantly, this cysteamine effect after washout was further sustained by the sequential administration of epigallocatechin gallate (EGCG), a green tea flavonoid, both in vivo, in mice, and in vitro, in primary epithelial cells from CF patients. In a pilot clinical trial involving 10 F508del-CFTR homozygous CF patients, the combination of cysteamine and EGCG restored BECN1, reduced SQSTM1 levels and improved CFTR function from nasal epithelial cells in vivo, correlating with a decrease of chloride concentrations in sweat, as well as with a reduction of the abundance of TNF/TNF-alpha (tumor necrosis factor) and CXCL8 (chemokine [C-X-C motif] ligand 8) transcripts in nasal brushing and TNF and CXCL8 protein levels in the sputum. Altogether, these results suggest that optimal schedules of cysteamine plus EGCG might be used for the treatment of CF caused by the F508del-CFTR mutation

Viene descritta come sia strutturata la formazione pediatrica nei Paesi dell’Unione Europea. Lo spunto per lo studio è stato offerto dalle notizie circolate negli ultimi mesi relative all’intenzione di alcuni governi dell’Unione di ridurre il periodo di formazione pediatrica post-laurea dagli attuali 5 anni, considerati un consolidato standard formativo per la Pediatria generale e specialistica, a 4 anni, che è indicata da una direttiva dell’Unione Europea come la durata minima per garantire che un training pediatrico possa essere considerato almeno qualitativamente sufficiente. Il dato principale e di significativo rilievo discusso sulla base di uno studio effettuato dall'Autore, è che su 28 Paesi dell’Unione ben 23 hanno adottato un percorso di formazione pediatrica post-laurea della lunghezza di 5 anni, che si basa tipicamente su una struttura formativa che include 3 anni di training di Pediatria generale (il cosiddetto tronco comune) e 2 anni di training elettivo e rotazioni in diverse sub-specialità pediatriche.

The Article outlines the contribution of health economics to the realization of child-friendly health care. The application of classic economic adult health care cost models to child health care is technically difficult because child health care is often more complex and less standardized than adult care (eg, pediatricians are not only treating diseases but the whole child and the family). Up to 8000 rare diseases are the main causes for children with long-term conditions, thus making the use of diagnosis-related group (DRG) systems very difficult to implement. Measures such as quality-adjusted life years (QALYs) developed for adults may be insensitive to the needs of children for a number of reasons, including the lack of appropriate measures and long-term studies. In summary, there appears to be no role for overly dogmatic economic guidelines in child health, but a high degree of innovation and flexibility is required on which stakeholders in society must agree. The economic models for child health care may have to be adjusted according to different age groups, conditions, settings, and countries.

Goals for the delivery and evaluation of postgraduate medical education is based on the primary goal of medical education: to prepare physicians to improve the health and health care of the general public through the education of physicians. These principles are based on the importance to creating the “ideal” postgraduate medical education system. Post graduate trainees play a valuable and active role in improving the system both from a learner- and patient-centered perspective. As with many things in life, medical education is not static. However, to change a consolidated approach to teaching and learning is not easy, and typically part of ourselves and our personal past experiences as trainees and trainers it must be left behind. It is important that loyalty to the past does not cloud our minds or prevent us from sharing in the joy and satisfaction with what will be possible in the years ahead, if we allow it to happen. The Report will address the current status and changes in education and training system for health professionals needed to support the modernization process of health care in Europe

National and international medical congresses are an integral part of continuous professional development for health scientists and clinicians. Two publications, however, have recently raised considerable concern about their value or whether they are merely “a profitmaking enterprise.” Medical congresses are becoming larger, more luxurious, and expensive, and, as a result, their cost-benefit ratio may be decreasing. This review discusses the future of international pediatric congresses and how they can contribute to the education of pediatricians. Authors, representing the European Paediatric Association leadership, outline how the challenges may be tackled by using innovative strategies for future pediatric congresses.

Maltreatment is a common cause of children’s functional and emotional impairment. Costs for the society are high, as a substantial amount of resources have been allocated for various types of services connected to maltreatment of children. These include acute treatment, long-term care, family rehabilitation programs, and judiciary activities.There is a long-lasting debate on how child abuse could be prevented or reduced. How can the costs of related services be contained? What is the role of pediatricians in such efforts? This article raises these important questions within the framework of the debate opened by the article by Gerber-Grote et al regarding the role of health economics in improving children’s health care.

Over the last few years, several countries of the European Union (EU) have dealt with increasing numbers of unaccompanied minor migrants, mainly originating from countries experiencing armed conflicts and oppression, or abuses of human rights. These children, also defined as “separated children,”1 are under 18 years of age, are outside their home country, apart from their parents or their previous legal or customary primary caregiver, and are traveling to Europe typically to escape conditions of serious deprivation or exploitation. These children are fragile, whether physically, intellectually, or socially. They lack the care and protection of their caregivers, and may be easily exposed to abuse and neglect. Because of their particular helpless condition, the unaccompanied minor migrants are at serious risk to be further deprived of their rights, and to become de facto “invisible” to the authorities, to the public health services, and in general to the public opinion. Furthermore, when they arrive at a destination, or during their journey through Europe, many children often vanish. The aim of this article is to raise awareness of the “invisible children,” particularly in those countries that only recently have experienced a mass migration of populations from different endangered parts of the world.

There is a need for guidelines on the diagnosis and treatment of cow’s milk allergy (CMA) / food allergy (FA) in infants [1]. Purpose. To establish guidelines for the management of infants with CMA/FA. A group of general paediatricians, paediatric nutritionists and allergists analysed a survey [1] which demonstrated the need for guidelines on the management of CMA /FA in infants. General recommendations for the management of CMA/FA by primary care paediatricians (PCP) were proposed. The diagnosis of CMA/FA among PCPs needs to focus on the clinical history and allergen-specific s-IgE. An elimination diet should be prescribed, in the case of CMA an eHF, followed by symptomatic improvement. When tolerance is proven after accidental ingestion or by formal challenge, an unrestricted diet should be instituted. There should be close cooperation with local allergy specialists regarding referrals.

The Article discuses "The New Nutrition Science project" and its impact in society. The project has raised the awareness of professionals working in nutrition science and in food and nutrition policy. Professionals are all now more aware of the importance of taking an integrated biological, social and environmental approach when confronting the challenges of a rapidly changing world. Since the conceptual framework of the New Nutrition was agreed in 2005, the world has significantly changed. The general social, economic, environmental and other transformations that were foreseen and analysed a decade ago by the team of Nutrition experts at the University of Giessen in Germany, at the beginning of the new millennium, have continued to evolve. However, the article emphasizes that the New Nutrition Science conceptual framework enables professionals and policy makers to take a proper approach in the field of nutrition considering its important implication for populations, regardless of any geographical area and age group.

This paper describes the Paediatric Ambulatory Consulting Service (PACS) project, developed by ASL-BT (Azienda Sanitaria Locale, Barletta-Andria-Trani), an Italian regional Public Health Centers network, in response to the current global situation of economic distress. PACS consist in integrating existing public health care services that are independently provided by hospitals and the Primary Care Paediatrics network. It has been developed with the aim to establish innovative yet efficient managerial solutions able to rationalize the resources not weakening the quality of services provided to the population.

Managing the health care of infants, children, and adolescents in Europe requires balancing clinical aims, research findings, and socioeconomic goals within an international environment characterized by cultural and economic complexity and large disparity in availability, affordability, and accessibility of pediatric care. In summary, in the 36 years of the existence of EPAUNEPSA, it became clear that the diversity of pediatric care among 53 different countries in Europe is immense. Annual meetings with national pediatric presidents focus on the most urgent problems of pediatric health care. The main research activities of EPA-UNEPSA concentrate on identifying the demography of primary, secondary, and tertiary care pediatrics in Europe, with the objective of promoting strong advocacy and political intervention in order to ensure the delivery of high-quality health care to children throughout Europe.

Managing the health care of infants, children, and adolescents in Europe requires balancing clinical aims, research findings, and socioeconomic goals within an international environment characterized by cultural and economic complexity and large disparity in availability, affordability, and accessibility of pediatric care. This report explores how EPA-UNEPSA has gone through evolutionary periods as well as the formulation of clinical aims. This is the first of several reports examining the highlights of EPA and EUROPAEDIATRICS, including the research activities according to each stage of development.

ver the past few years, an increasing number of European pediatricians, particularly primary care pediatricians, are facing the growing threat of vaccine hesitancy and refusal, a sort of a “cultural epidemic,” which seems to progressively affect the families of children under their care. In several communities, a growing number of individuals are delaying or refusing available recommended and/or mandatory vaccinations for themselves and their children. Furthermore, vaccination is increasingly perceived as unsafe and unnecessary by a rising number of parents, although it has been widely proven and recognized to be one of the greatest, safest, and most successful public healthmeasures ever adopted.The aim of the article is to describe vaccine hesitancy and refusal in an effort to further raise the awareness of pediatricians on this potential threat for their communities, and, in particular, for children under their care. Definition and Effects of V