[Incidence and cost of hospitalizations for bronchiolitis and respiratory syncytial virus infections in the autonomous community of Valencia in Spain (2001 and 2002)]. / Incidencia y costes de la hospitalización por bronquiolitis y de las infecciones por virus respiratorio sincitial en la Comunidad Valenciana. Añ 2001 y 2002.

OBJECTIVE: To assess the incidence and costs of hospitalizations for bronchiolitis and respiratory syncytial virus (RSV) infections the Autonomous Community of Valencia, Spain. METHODS: The minimum data set (MDS) of the Autonomous Community of Valencia was analyzed. Hospital discharges with the codes for bronchiolitis (with or without etiologic determination) and RSV infections occurring in 2001 and 2002 in children less than 2 years old were included. Second cases of bronchiolitis and RSV infections of possible nosocomial origin occurring during prolonged hospitalization were excluded. The average cost of hospitalization in a pediatric ward was estimated at euro 310.30 per day. To calculate the incidence, we assumed that 95 % of the hospitals reported to the MDS; the population used was that of the National Census, 2001. RESULTS: A total of 3,705 hospitalizations were obtained, of which 3,507 were coded as bronchiolitis and 42.2 % of these were RSV-positive. Virological assessment varied greatly among hospitals. Hospitalizations were most frequent between October and April, with no differences between the two years. The incidence of bronchiolitis hospitalization was 40.2 cases/1000 children < 1 year/year, with an average annual cost of 3,618 thousand Euros. CONCLUSIONS: The cost of bronchiolitis hospitalizations is high. Microbiological investigation is low in some hospitals, leading the economic impact of RSV on society to be underestimated.

[Epidemiology of community-acquired pneumonia in children aged less than 5 years old in the Autonomous Community of Valencia (Spain)]. / Epidemiología de la neumonía adquirida en la comunidad en menores de 5 años en la Comunidad Valenciana.

OBJECTIVE: To assess the incidence of community acquired pneumonia in the Autonomous Community of Valencia in Spain, and describe its treatment and complications. METHODS: A retrospective cohort comprising 654 children born in 1995 and 1996 in Valencia and followed-up during the first 5 years of life by nine pediatricians was studied. The number of cases of pneumonia, treatment, complications and interventions was recorded. RESULTS: Ninety-nine episodes of community-acquired pneumonia in 80 children were recorded (1.24 cases/child). Fifty-one cases (51.1 %) occurred before the child's third birthday and 38 (38.4 %) occurred between the third and the fourth. Of the 99 cases, 51 were diagnosed in primary care and 46 in the emergency room. There was a mean of 2.44 visits per process in primary care (range 1-6). All the children were treated with antibiotics. The most frequently used were amoxicillin-clavulanate (43.3 %) and cefuroxime (26.3 %). Fourteen patients required a change of antibiotic. Twenty-three percent of the children were hospitalized. CONCLUSION: The incidence of community-acquired pneumonia in Valencia was 30.3 cases/1000 children aged less than 5 years/ year (95 % CI: 18.7-46.8), and the incidence of hospitalization was 7.03 cases/1000 children aged less than 5 years/year.

[Epidemiology and burden of acute otitis media in Valencia (Spain)]. / Epidemiología e impacto de la otitis media aguda en la Comunidad Valenciana.

OBJECTIVE: To assess the burden (incidence, treatment and complications) of acute otitis media (AOM) and otitis media with effusion (OME) in children younger than 5 years of age from Valencia, Spain. SUBJECT AND METHODS: We performed a retrospective cohort study of 1,399 children followed-up for the first 5 years of life. Seventeen pediatricians reviewed the medical records of their patients born in 1995 and 1996 and followed-up from birth until the age of 5 years. For each child, the number of otitis episodes, treatment, complications, and surgical interventions was obtained. RESULTS: There were 2,961 episodes of AOM in the first 5 years of life (2.23 cases/child). Four hundred seventy-six cases (16.1 %) occurred before 1 year of age and 1,346 between the first and second year of life (45.5 %). By the third year of life, 59.8 % had had at least one episode. In most children (80.9 %), diagnosis was made in primary care and required a median of 1.81 visits/episode for follow-up. A total of 94.5 % were treated with antibiotics (amoxicillin-clavulanate 38.8 %, cefuroxime 14.3 %, clarithromycin 8.2 % and amoxicillin 5.9 %) and 8.5 % required a change of antibiotic therapy. Two hundred seventeen children (15.2 %) had at least one episode of OME. Twenty-six patients (1.8 %, 95 % CI: 1.2-2.7 %) required insertion of ventilation tubes. Twenty-four patients (1.7 %) had secondary hypoacusis. There was one case of meningitis and two cases of chronic otorrhea. No cases of mastoiditis were recorded. CONCLUSIONS: The incidence of AOM in Valencia is 40,014 episodes/100,000 children younger than 5 years/year (95 % CI: 39,700-40,300). It represents a significant burden due to the large number of visits, antibiotic use, associated surgical procedures and need for auditory rehabilitation.

[Modification of the vaccination technique with DTP in nursing infants after 1 intervention]. / Modificación de la técnica vacunal con DTP en el lactante tras una intervención.

OBJECTIVES: To evaluate alterations in techniques of DTP vaccination of nursing children after a two-year intervention and analyse the reasons for reluctance to change the norms. DESIGN: A longitudinal and prospective study, with intervention before and after. Evaluation through two anonymous questionnaires of staff in charge of the vaccinations: a general survey for each centre and an individual one for each nurse. SETTING: Primary care. PARTICIPANTS: The professionals in charge of vaccinations of nursing children in the 13 health centres and clinics in areas 11 and 12 of the Valencian Community in 1993. INTERVENTION: Informative meetings with paediatricians and nurses to pass on the recommendations of experts on vaccination techniques, supported by written information to the person in charge of vaccinations at each centre. MEASUREMENTS AND MAIN RESULTS: Out of the 13 centres 12 returned the general survey in 1993 and 11 in 1995. The individual questionnaire was returned by 49 nurses. From the 12 centres injecting in the gluteus in 1993, 5 changed to the thigh and all now use 25 mm-long needles. The reasons for not changing the site of the injection were basically the greater number of side-effects and that the paediatricians did not consider it necessary. CONCLUSIONS: Vaccination techniques are usually altered after the intervention, though still not sufficiently.

[Evaluation of the DTP vaccination technique in infants]. / Evaluación de la técnica de vacunación con DTP en el lactante.

OBJECTIVE: To evaluate the techniques of DPT vaccination in the nursing child. DESIGN: An observation study of a crossover type. Evaluation by means of an anonymous survey of those responsible for administering the vaccinations. Statistical analysis using the precise Fisher test. PARTICIPANTS: The thirteen official vaccination centres in Health Areas 11 and 12 in the Community of Valencia. MEASUREMENTS AND MAIN RESULTS: 12 centres (91%) answered the questionnaire. Four of them (41%) used different needles to aspirate the contents of the vial and give the injection to the nursing child. The DPT was always administered in the gluteal region. 33% used needles which were 16 mm long. Prophylactic paracetamol was used in two of the Centres as a matter of course. The Centre's size or length of time in use did not affect the techniques used. CONCLUSIONS: There is no uniformity in the technique of administering the DPT vaccine to the nursing child in the different Vaccination Centres of Areas 11 and 12 in the Community of Valencia. The techniques used for vaccinations often differ from those recommended by groups of experts.

[Validation of the tympanic thermometer in primary care]. / Validación del termómetro timpánico en atención primaria.

OBJECTIVE: The aim of the study is to validate a tympanic thermometer (TT) use in primary care. PATIENTS AND METHODS: Validation study phase IV of the tympanic thermometer ThermoScan Pro LT. Measurements are compared to axillary temperature (AT) measured with a glass mercury thermometer. 412 subjects 6 months to 15 years old attended in primary care clinics were studied. Exclusion criteria were middle ear conditions, intense crying or sweating. The highest of the three measurements in each ear was used to calculate sensitivity and specificity of the TT and to analyse the concordance with AT. The impact of ambient temperature, age, gender, cerumen, presence of a febrile condition and the examiner on the results was assessed. RESULTS: Sensitivity of TT to detect fever (AT > 38 degrees C) was 89.7% (95% IC: 81.8-97.5) and specificity 90.7% (95% IC: 87.7-93.7). As a mean TT measures 0.5 degree C higher than AT but there was a high dispersion of the data (-1.59-0.6 degrees C). Accuracy of TT was influenced by the sex of the patient (p = 0.029), examiner (p < 0.01), presence of a febrile condition (p < 0.01) and positioning of the patient (p = 0.026). Repeatability coefficient was 0.34 degree C for the right ear and 0.42 degree C for the left. CONCLUSION: The sensitivity of the TT to detect fever was adequate, though there was a poor concordance with AT and had an important variation among repeated measurements in the same ear.

[Use of alternating antipyretics in the treatment of fever in Spain]. / Utilización de la alternancia de antipiréticos en el tratamiento de la fiebre en España.

OBJECTIVE: To assess the frequency of the use of alternating antipyretics among Spanish pediatricians and to analyze the factors that determine this practice. METHODS: An anonymous survey of practicing pediatricians was conducted. Data on the use of antipyretics were collected. Factors related to alternating antipyretics were assessed by using multivariate correlation analyses. RESULTS: Three hundred twenty-four questionnaires were reviewed. The mean age of participants was 46.4 18.6 years (29-68 years). Of the responding pediatricians, 22.5 % worked in hospitals, 87.5 % in health centres and 24.7 % in in private practice. A total of 68.8 % of pediatricians (95 % CI: 63.4-73.8 %) alternated antipyretics. The combination of ibuprofen and acetaminophen was recommended by 96.9 %. The use of alternating antipyretics was positively associated with male sex (OR: 0.535; 95 % CI: 0.296-0.967; p 0.038), with few years' experience (OR: 0.952; 95 % CI: 0.922-0.984, p 0.005), with considering ibuprofen the drug of choice (OR: 2.324; 95 % CI: 1.235-4.372; p 0.009) and with the doctor's recommendation that the antipyretic be readministered in the event of slight increases in temperature (OR: 0.529; 95 % CI: 0.310-0.901; p 0.019). CONCLUSIONS: Despite the lack of scientific evidence to justify the practice, the use of alternating antipyretics is common in the treatment of febrile children. Predictive factors of this practice among pediatricians are male sex, having relatively little experience, considering ibuprofen as the drug of choice and recommending the administration of new doses of antipyretic to control mild fever.

[The coverage of vaccines systematically administered and of a vaccine against Haemophilus influenzae type b prior to its inclusion in the vaccinal calendar in the Valencian Community]. / Cobertura de las vacunas administradas sistemáticamente y de la vacuna frente a Haemophilus influenzae tipo b previa a su incorporación al calendario vacunal en la Comunidad Valenciana.

OBJECTIVE: The objective of this study was to estimate the vaccine coverage among children two years of age in the Community of Valencia, Spain, in 1997. PATIENTS AND METHODS: Cluster sampling was used to assess vaccine coverage. Clusters were villages randomized according to their population < 5 years of age. At least 7 children of each of the 30 selected clusters were randomly selected from the database of newborn metabolic screening. Parents were contacted and vaccine registration cards requested by mail. RESULTS: Four hundred forty subjects were selected. Eight percent of the families had moved and were not contacted. Sixty-nine percent participated in the study. Coverage for three doses of DTP was 97.8% and 87.6% for four doses. MMR vaccine coverage was 96.6% and three doses of hepatitis B had been given in 95.1%. H. influenzae type b (Hib) vaccine coverage was 57%. In 70% of the studied cases of non-participants, vaccine coverage was known through vaccination centers and was very similar to that of the participants. CONCLUSIONS: Vaccine coverage in the Community of Valencia is high for the scheduled vaccines. Although Hib is not a scheduled vaccination, its coverage was 57%.