First steps towards the deinstitutionalization of older adults: A protocol for the implementation of a complex intervention.

BACKGROUND: Nursing homes are becoming increasingly important as end-of-life care facilities. However, many older adults want to stay in their homes as they age. OBJECTIVE: To assess the feasibility of a deinstitutionalization process on selected institutionalized older adults who are willing to initiate the process. METHODS: This study, divided into two phases, will be carried out over 15 months on 241 residents living in two nursing homes in Navarra (Spain). The first phase has a cross-sectional design. We will identify the factors and covariates associated with feasibility and willingness to participate in a deinstitutionalization process by bivariate analysis, essential resources for the process and residents to participate in the process. The second phase has a complex interventional design to implement a deinstitutionalization process. An exploratory descriptive and comparative analysis will be carried out to characterize the participants, prescribed services and the impact deinstitutionalization intervention will have over time (quality of life will be the main outcome; secondary variables will be health, psychosocial, and resource use variables). This study will be accompanied by a pseudo-qualitative and emergent sub-study to identify barriers and facilitators concerning the implementation of this process and understand how intervention components and context influence the outcomes of the main study. Intervention components and the way the intervention is implemented will be of great relevance in the analysis. DISCUSSION: Alternatives to institutionalization with adapted accommodation and community support can allow people who wish to return to the community. TRIAL REGISTRATION: NCT05605392.

A Paradigm Shift on Deinstitutionalization and Dementia Care: A Narrative Review.

This narrative explores the impact of deinstitutionalization policies on the quality of life and care outcomes for individuals with Alzheimer's disease and related dementias. We offer a historical perspective on these policies, their implications on dementia care, and the barriers to deinstitutionalization. The potential benefits of deinstitutionalization, such as improved quality of life and access to community-based support and services, are highlighted. Challenges and controversies surrounding safety, caregiver burden, and resource allocation are also examined. Ethical considerations related to the autonomy and decision-making capacity of people living with dementia are discussed. We present best practices and innovative models in dementia care that balance deinstitutionalization with appropriate care. We further put forth recommendations for future research and policy development in dementia care and deinstitutionalization, emphasizing the need for a balanced approach that respects the autonomy and preferences of people living with dementia while ensuring their safety and well-being.

Migraine treatment consensus document of the Spanish Society of Neurology (SEN), Spanish Society of Family and Community Medicine (SEMFYC), Society of Primary Care Medicine (SEMERGEN) and Spanish Association of Migraine and Headache (AEMICE) on migraine treatment. / Documento de consenso de la Sociedad Española de Neurología (SEN), Sociedad Española de Medicina de Familia y Comunitaria (SEMFYC), Sociedad de Medicina de Atención Primaria (SEMERGEN) y Asociación Española de Migraña y Cefalea (AEMICE) sobre el tratamiento de la migraña.

Migraine is a disease with a high prevalence and incidence, in addition to being highly disabling, causing a great impact on the patient's quality of life at a personal, family and work level, but also social, given its high expense due to its direct (care) and indirect (presenteeism and work absenteeism) costs. The multiple and recent developments in its pathophysiological knowledge and in its therapy require updating and, therefore, in this article the Spanish scientific societies most involved in its study and treatment (SEN, SEMFYC and SEMERGEN), together with the Association Spanish Association for Patients with Migraine and other Headaches (AEMICE), we have developed these updated care recommendations. We reviewed the treatment of migraine attacks, which consisted mainly of the use of NSAIDs and triptans, to which ditans and gepants have been added. We also discuss preventive treatment consisting of oral preventive drugs, botulinum toxin, and treatments that block the action of calcitonin-related peptide (CGRP). Finally, we emphasize that pharmacological treatments must be complementary to carrying out general measures consisting of identifying and managing/deletion the precipitating factors of the attacks and the chronicizing factors, controlling the comorbidities of migraine and eliminating analgesic overuse.

Actionable mutational profiling in solid tumors using hybrid-capture-based next-generation sequencing in a real-world setting in Spain.

OBJECTIVE: This study aimed to describe the performance of a next-generation sequencing (NGS) panel for the detection of precise genomic alterations in cancer in Spanish clinical practice. The impact of tumor characteristics was evaluated on informative NGS and actionable mutation rates. MATERIALS AND METHODS: A cross-sectional study was conducted at the Fundación Jiménez Díaz University Hospital (May 2021-March 2022) where molecular diagnostic of 537 Formalin-Fixed Paraffin-Embedded (FFPE) tissue samples of diverse solid tumors (lung, colorectal, melanoma, gastrointestinal stromal, among others) was performed using AVENIO Tumor Tissue Targeted Kit. A descriptive analysis of the features of all samples was carried out. Multivariable logistic analysis was conducted to assess the impact of sample characteristics on NGS performance defined by informative results rate (for all tumors and for lung tumors), and on actionable mutations rate (for lung tumors only). RESULTS: AVENIO performance rate was 75.2% in all tumor samples and 75.3% in lung cancer samples, and the multivariable analysis showed that surgical specimens are most likely to provide informative results than diagnostic biopsies. Regarding the mutational findings, 727 pathogenic, likely pathogenic, or variant of unknown significance mutations were found in all tumor samples. Single nucleotide variant was the most common genomic alteration, both for all tumor samples (85.3% and 81.9% for all solid tumors and lung samples, respectively). In lung tumors, multivariable analysis showed that it is more likely to find actionable mutations from non-smokers and patients with adenocarcinoma, large cell, or undifferentiated histologies. CONCLUSION: This is the largest cohort-level study in Spain to profile the analyses of biopsy samples of different tumors using NGS in routine clinical practice. Our findings showed that the use of NGS routinely provides good rates of informative results and can improve tumor characterization and identify a greater number of actionable mutations.

Case report: Uncommon gastric metastasis as a presentation of recurrent clear cell renal cell carcinoma.

Renal cell carcinoma (RCC) is a kidney neoplasm that accounts for 85% of cases and has complex genetic pathways that affect its development and progression. RCC metastasis can occur in 20%-50% of patients and usually affects distant organs. Gastric metastases (GM) from RCC are rare and present as polyp-like growths in the submucosal layer, accounting for 0.2%-0.7% of cases. This case report describes an 84-year-old female with Furhman grade II ccRCC who presented with an atherothrombotic ischemic stroke and gastrointestinal bleeding nine years post-radical nephrectomy. Gastroscopy revealed a 12mm pseudopedicled gastric lesion with ulceration and bleeding, diagnosed as metastatic ccRCC. The discussion focuses on the rarity, diagnostic challenges, and prognostic elements of gastric metastasis from RCC. The median survival after detecting digestive metastasis varies widely, and the mechanisms include direct invasion and dissemination through lymphatic, transcelomic, or hematogenous routes. Prognostic markers encompass patient history, symptoms, time since RCC diagnosis, overall health, and genetic factors. Surgical removal of gastric lesions and targeted therapy are treatment options that can improve survival. This case report highlights the need for further research to enhance diagnostic and treatment strategies for this rare aspect of RCC pathophysiology.

Development and Independent Validation of a Prognostic Gene Expression Signature Based on RB1, PTEN, and TP53 in Metastatic Hormone-sensitive Prostate Cancer Patients.

BACKGROUND: Androgen deprivation therapy (ADT) with docetaxel (D) and/or antiandrogen receptor therapies (ARTs) are the standard therapies in metastatic hormone-sensitive prostate cancer (mHSPC). Alterations in the tumor suppressor genes (TSGs) RB1, PTEN, and TP53 are associated with an aggressive evolution and treatment resistance in castration-resistant prostate cancer (CRPC). OBJECTIVE: To study the clinical implications of TSG mRNA expression in mHSPC patients. DESIGN, SETTING, AND PARTICIPANTS: This is a multicenter retrospective biomarker study in mHSPC patients. TSGlow status was defined when two or more out of the three TSGs presented low RNA expression by nCounter in formalin-fixed paraffin-embedded samples and TSGwt for the remaining cases. The microarray data from the CHAARTED trial were analyzed as an independent validation cohort. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Molecular data were correlated with CRPC-free survival (CRPC-FS) and overall survival (OS) by the Kaplan-Meier method and multivariate Cox analysis. RESULTS AND LIMITATIONS: A total of 226 patients were included, of whom 218 were eligible: 93 were treated with ADT and 125 with ADT + D; 75.7% presented de novo stage IV and 67.9% high-volume disease. TSGlow (19.2%) was independently correlated with shorter CRPC-FS (hazard ratio [HR] 1.8, p = 0.002) and OS (HR 2, p = 0.002). In the CHAARTED trial, TSGlow was independently correlated with lower CRPC-FS (HR 2.2, p = 0.02); no differences in clinical outcomes according to treatment were observed in TSGlow patients, while a significant benefit was observed for ADT + D in the TSGwt group for CRPC-FS (HR 0.4, p < 0.001) and OS (HR 0.4, p = 0.001). However, no interaction was observed between TSG signature and treatment in either series. Study limitations are the retrospective design, small sample size, and lack of inclusion of patients treated with ADT + ART. CONCLUSIONS: TSGlow expression correlates with adverse outcomes in patients with mHSPC. The investigation of new therapeutic strategies in these patients is warranted. PATIENT SUMMARY: The low RNA expression of tumor suppressor genes in the tumors is correlated with adverse outcomes in patients with metastatic hormone-sensitive prostate cancer.

Microstructure and Wear Behavior of Heat-Treated Mg-1Zn-1Ca Alloy for Biomedical Applications.

The microstructure and wear properties of a Mg-1wt.% Zn-1wt.% Ca (ZX11) alloy with different heat treatments have been investigated. The ZX11 alloy was tested in the as-cast state and after different heat treatment conditions: solution-treated (at 450 °C for 24 h), peak-aged (solution-treated + aged at 180 °C for 3 h), and over-aged (solution-treated + aged at 180 °C for 24 h). The microstructure of the as-cast sample showed a continuous intermetallic phase at the grain boundaries, while the heat-treated samples exhibited discrete precipitated particles within the grains. To evaluate the wear behavior, the samples were tested using a pin-on-disc configuration, where the wear rates and friction coefficients were measured at different loads and sliding speeds. An AZ31 magnesium alloy was used as the counterbody. The worn surfaces and the wear debris were studied to identify the main wear mechanisms corresponding to each test condition. The results indicated the presence of abrasion, oxidation, and adhesive wear mechanisms in all testing conditions. In the as-cast state, delamination and plastic deformation were the dominant wear mechanisms, while they were less relevant in the heat-treated conditions. The peak-aged samples exhibited the lowest wear rates, suggesting that modifying the distribution of intermetallic precipitates contributed to enhancing the wear resistance of the alloy.

Estrategia de orientación psicopedagógica para la prevención del síndrome de Burnout Laboral / Psychopedagogical Strategy for preventing Burnout Syndrome at workplace

RESUMEN Introducción: el síndrome de Burnout consiste en una respuesta prolongada del organismo ante los factores estresantes, emocionales e interpersonales que se presentan en el trabajo e incluye fatiga crónica, ineficacia y negación de lo ocurrido. Se suele presentar en aquellas situaciones laborales en las que los excesivos niveles de exigencia ya se han vuelto un hábito inconsciente e incluso socialmente valorado. Objetivo: elaborar una estrategia de orientación educativa a los profesores desde la función orientadora del psicopedagogo, para la prevención del Síndrome de Burnout Laboral. Métodos: se realizó un estudio descriptivo, prospectivo y cualitativo mediante los métodos teóricos y empíricos, como: histórico-lógico, análisis-síntesis, encuestas, entrevistas, observación, técnica grupal e inventario para la evaluación del Burnout. Resultados: los resultados permitieron precisar las manifestaciones de este síndrome y sus insuficiencias. En la muestra estudiada se comprobó que de 19 profesionales se manifiestan en 15 (79%), en alguna medida indicadores de esta afectación, como síntomas de cansancio emocional y la baja realización personal. Conclusiones: la estrategia de orientación aplicada contribuye con la preparación del psicopedagogo en la prevención del Síndrome de Burnout Laboral y perfecciona el proceso docente educativo, proporciona mayor estabilidad psicológica y favorece la unidad de influencias educativas.

ABSTRACT Introduction: Burnout syndrome is provoqued by a prolonged response of the organism to stress, emotional and interpersonal factors such as chronic fatigue, inefficiency and refutation. It is usually present in those workers with ridiculous levels of tasks have already become an unconscious and social habit. Objective: to elaborate an educational guidance strategy for teachers, according to their function of Psychopedagogue for Burnout syndrome prevention. Methods: a descriptive, prospective and qualitative study was carried out using theoretical and empirical methods such as: historical-logical, analysis-synthesis, surveys, interviews, observation, group technique and Burnout syndrome records. Results: there were insufficiencies. From the total sample of 19 professionals, some indicators revealed 15 (79%) of participants with emotional fatigue and low self-realization highlighted symptoms. Conclusions: the strategy contributes to prepare the psychopedagogue on Burnout syndrome prevention and improves the educational process. It also provides greater psychological stability and favors educational influences unity.

Hipertricosis cubital en una paciente con pubarquia precoz: Caso clmico / Hypertrichosis cubiti in a girl with precocious puberty: Case report

La hipertricosis cubital es un aumento localizado de la densidad, longitud y espesor del vello. Es una entidad benigna con muy escasos pacientes descritos en la literatura médica (alrededor de medio centenar). La mitad de los casos descritos asocian otros defectos o malformaciones, y la otra mitad son problemas puramente estéticos. La pubarquia precoz en niñas se define como el inicio del vello púbico antes de los 8 años de edad. Se presenta a una paciente de 6 años con la asociación no descrita previamente de hipertricosis cubital y pubarquia precoz.

Hypertrichosis cubiti is a localized increase in hair density, length and thickness. It is an uncommon and benign entity with very few patients described in the medical literature (more or less than half a hundred). Half of the described patients associate other defects or malformations and the other half are purely aesthetic cases. Early pubarche in girls is defined as the onset of pubic hair before 8 years of age. We present a six-year-old patient with the association not previously described of hypertrichosis cubiti and precocious pubarche.

Enfermedad de Osgood-Schlatter en un adolescente deportista: Caso clínico / Osgood-Schlatter disease in adolescent athlete: Case report

El dolor de rodilla es uno de los síntomas musculoesqueléticos más frecuentes en jóvenes físicamente activos y aparece, sobre todo, en adolescentes varones. Dentro del diagnóstico diferencial, hay que considerar entidades habituales de diagnóstico clínico, como la osteocondrosis apofisaria, y también otras en las que se precisan estudios complementarios. Se presenta el caso de un varón deportista de 12 años con dolor continuo en la rodilla derecha que se intensificaba con la actividad física y la presión directa. Se hizo el diagnóstico de enfermedad de Osgood-Schlatter mediante los datos exploratorios, reproducción del dolor ante la palpación a punta de dedo sobre la tuberosidad tibial anterior, y se confirmó mediante radiología. Se describe esta entidad y otras derivadas de la sobreutilización en la actividad física con las que hacer diagnóstico diferencial; se insiste en las medidas preventivas en cuanto a una correcta orientación en la actividad deportiva.

Knee pain is one of the most frequent musculoskeletal symptoms in young physically active males. Common entities of clinical diagnosis as osteochondritis/apophysitis and others that need complementary studies should be considered in the differential diagnosis. We present the case of a 12-year-old male athlete with continuous pain in his right knee that intensifies with physical activity and with direct pressure. Diagnosis of Osgood-Schlatter disease is made by exploratory data, pain-to-finger palpation on the anterior tibial tuberosity, and is confirmed by radiology. This entity is described as well as the main pathologies derived from overuse to make differential diagnosis and to stress preventive measures regarding a correct orientation in the sport activity.

Valoración de las madres acerca de las recomendaciones para el cuidado del recién nacido al momento del alta hospitalaria / Maternal assessment of recommendations on the newborn infant care upon hospital discharge

Introducción. Es habitual que el pediatra ofrezca a los padres información sobre cuidados del neonato al momento del alta hospitalaria. Los objetivos del estudio son conocer la satisfacción respecto a dicha información, qué otras informaciones les hubiese gustado recibir y determinar qué factores pueden influir en esa demanda. Población y métodos. Estudio descriptivo que evalúa la opinión de las puérperas a los 5-15 días del parto, en cuanto a dicha información. Resultados. Se recogieron 176 encuestas. El 68,8% asistió a clases de preparación para el parto. El 61,4% refirió haber buscado consejos sobre cuidados del recién nacido, mayoritariamente en internet y libros. El 74,4% consideró suficiente la información recibida. Los aspectos de información más demandados fueron lactancia materna (33,3%), artificial (20,0%) y cuidados del cordón umbilical (11,1%). Las madres que demandaron más información acudieron con más frecuencia a clases de preparación para el parto (significativo) y buscaron información durante la gestación (no significativo). Asimismo, este grupo otorgó significativamente peores puntuaciones a la facilidad para plantear dudas y el grado de confianza en el pediatra. Conclusiones. La satisfacción de las madres respecto a la información ofrecida es buena; la mayoría no demanda más información. El aspecto sobre el que con más frecuencia demandan más información es la lactancia. La demanda de información es independiente de la edad materna, los estudios maternos, la situación laboral o la existencia de hijos previos. Asimismo, las dudas que les surgen a las madres no se ven satisfechas únicamente por la asistencia a clases de preparación para el parto.

Introduction.It is common for pediatricians to provide parents with information on how to look after their newborn baby at the time of discharge from the hospital. The objectives of this study are to determine the level of satisfaction regarding such information, to be aware of what additional information parents would have liked to receive, and to establish which factors may impact any additional information request. Population and Methods.Descriptive study evaluating the opinion of women at 5-15 days post- partum regarding such information. Results.A hundred and seventy-six surveys were collected. Of these, 68.8% respondents had attended childbirth classes. Sixty-one point four percent referred to have looked for advice on the newborn infant care, mostly on the Internet and in books. Seventy-four point four percent considered that the information provided sufficed. Most commonly, information was requested on breastfeeding (33.3%), bottle feeding (20.0%), and umbilical cord care (11.1%). Mothers who requested more information attended childbirth classes more frequently (significant) and searched for information during pregnancy (not significant). In addition, this group significantly assigned a lower score to the opportunity to ask questions and the level of trust on the pediatrician. Conclusions.Maternal satisfaction regarding the information provided is adequate; and most mothers do not request additional information. The topic on which they most frequently request additional information is breastfeeding. The decision to request information does not depend on maternal age, maternal education, employment condition, or having other children. Likewise, mothers have questions that are not satisfactorily answered during childbirth classes.

Variabilidad e idoneidad en el tratamiento antimicrobiano de las faringoamigdalitis agudas pediátricas en Asturias, España / Variability of antibiotic treatment in paediatric acute pharyngotonsillitis in Asturias, Spain

Introducción. Las faringoamigdalitis agudas suponen un importante porcentaje de las consultas pediátricas y una de las principales causas de prescripción antibiótica. Nuestro objetivo fue analizar los hábitos de prescripción antimicrobiana en niños diagnosticados con faringoamigdalitis aguda en servicios de urgencias hospitalarios y consultas pediátricas de atención primaria en Asturias (España). Métodos. Estudio descriptivo multicéntrico que evalúa pacientes pediátricos diagnosticados con faringoamigdalitis aguda en los servicios de urgencias de 5 hospitales y en 80 consultas pediátricas de atención primaria. La idoneidad de las prescripciones se estableció por comparación con estándares de referencia. Resultados. Se incluyeron 563 niños con faringoamigdalitis agudas, 49,7% en atención primaria (IC 95% 45,6-53,8%), a los largo de 30 días no consecutivos (6,8% de las consultas pediátricas). Se prescribieron antibióticos en el 75,5% de las faringoamigdalitis (IC 95% 71,9-79,0%) [(78,3% en los menores de 3 años (IC 95% 71,8-84,8%)]. El antibiótico más indicado fue la amoxicilina [39,1% de los casos que recibieron antibioterapia (IC 95% 34,4-43,7%)]. Se encontraron diferencias significativas en el porcentaje de prescripción antibiótica entre atención primaria y urgencias hospitalarias (70,0% contra 80,9%, p= 0,003). El tratamiento prescrito se consideró de primera elección en el 43,3% de los tratados (IC 95% 38,6-48,0%) e inadecuado en el 56,0% (IC 95% 51,3-60,7%). Conclusiones. Pese a que la mayoría de las faringoamigdalitis agudas pediátricas son de probable etiología vírica, tres cuartas partes de ellas reciben tratamiento antibiótico en nuestro medio, siendo la elección inapropiada en más de la mitad de los casos.

Introduction. Acute pharyngotonsillitis accounts for a large portion of antibiotic prescriptions in pediatric offices. Our aim was to analyze the antimicrobial prescription habits for acute pharyngotonsillitis in children from hospital emergency departments and primary care pediatric clinics in Asturias (Spain). Methods. Multicenter descriptive study evaluating pediatric patients with a diagnosis of acute pharyngotonsillitis in 5 hospital emergency departments and 80 pediatric primary care clinics. Appropriateness of prescription was established by comparing with reference standards. Results. Five hundred sixty-three children with acute pharyngotonsillitis [49.7% in primary care CI 95% 45.6-53.8%)] were included along 30 nonconsecutive days. Antibiotics were prescribed in 75.5% of cases (95% CI 71.9-79.0%) [78.3% in children under 3 years of age (95% CI 71.8-84.8%)]. Amoxicillin was the antibiotic most frequently prescribed [39.1% (95% CI 34.4-43.7%)]. Significant differences in the frequency or antibiotic prescription were found between primary care and hospital emergency departments (70% vs. 80.9%, p= 0.003). The treatment prescribed was considered first choice in 43.3% (95% CI 38.6-48.0%) and inappropriate in 56.0% (95% CI 51.3-60.7%). Conclusions. Although in most cases pediatric acute pharyngotonsillitis is viral in origin, three out of four are treated with antibiotics. Treatment was inappropriate in more than half of the cases in our study.

Variabilidad e idoneidad en el tratamiento antimicrobiano de las faringoamigdalitis agudas pediátricas en Asturias, España / Variability of antibiotic treatment in paediatric acute pharyngotonsillitis in Asturias, Spain

Introducción. Las faringoamigdalitis agudas suponen un importante porcentaje de las consultas pediátricas y una de las principales causas de prescripción antibiótica. Nuestro objetivo fue analizar los hábitos de prescripción antimicrobiana en niños diagnosticados con faringoamigdalitis aguda en servicios de urgencias hospitalarios y consultas pediátricas de atención primaria en Asturias (España). Métodos. Estudio descriptivo multicéntrico que evalúa pacientes pediátricos diagnosticados con faringoamigdalitis aguda en los servicios de urgencias de 5 hospitales y en 80 consultas pediátricas de atención primaria. La idoneidad de las prescripciones se estableció por comparación con estándares de referencia. Resultados. Se incluyeron 563 niños con faringoamigdalitis agudas, 49,7% en atención primaria (IC 95% 45,6-53,8%), a los largo de 30 días no consecutivos (6,8% de las consultas pediátricas). Se prescribieron antibióticos en el 75,5% de las faringoamigdalitis (IC 95% 71,9-79,0%) [(78,3% en los menores de 3 años (IC 95% 71,8-84,8%)]. El antibiótico más indicado fue la amoxicilina [39,1% de los casos que recibieron antibioterapia (IC 95% 34,4-43,7%)]. Se encontraron diferencias signifcativas en el porcentaje de prescripción antibiótica entre atención primaria y urgencias hospitalarias (70,0% contra 80,9%, p= 0,003). El tratamiento prescrito se consideró de primera elección en el 43,3% de los tratados (IC 95% 38,6-48,0%) e inadecuado en el 56,0% (IC 95% 51,3-60,7%). Conclusiones. Pese a que la mayoría de las faringomigdalitis agudas pediátricas son de probable etiología vírica, tres cuartas partes de ellas reciben tratamiento antibiótico en nuestro medio, siendo la elección inapropiada en más de la mitad de los casos.

Introduction. Acute pharyngotonsillitis accounts for a large portion of antibiotic prescriptions in pediatric offces. Our aim was to analyze the antimicrobial prescription habits for acute pharyngotonsillitis in children from hospital emergency departments and primary care pediatric clinics in Asturias (Spain). Methods. Multicenter descriptive study evaluating pediatric patients with a diagnosis of acute pharyngotonsillitis in 5 hospital emergency departments and 80 pediatric primary care clinics. Appropriateness of prescription was established by comparing with reference standards. Results. Five hundred sixty-three children with acute pharyngotonsillitis [49.7% in primary care CI 95% 45.6-53.8%)] were included along 30 nonconsecutive days. Antibiotics were prescribed in 75.5% of cases (95% CI 71.9-79.0%) [78.3% in children under 3 years of age (95% CI 71.8-84.8%)]. Amoxicillin was the antibiotic most frequently prescribed [39.1% (95% CI 34.4-43.7%)]. Signifcant differences in the frequency or antibiotic prescription were found between primary care and hospital emergency departments (70% vs. 80.9%, p= 0.003). The treatment prescribed was considered frst choice in 43.3% (95% CI 38.6-48.0%) and inappropriate in 56.0% (95% CI 51.3-60.7%). Conclusions. Although in most cases pediatric acute pharyngotonsillitis is viral in origin, three out of four are treated with antibiotics. Treatment was inappropriate in more than half of the cases in our study.