Calidad de vida en lactantes nacidos prematuros según ingresos por infección respiratoria / Quality of life of preterm infants and admissions due to respiratory infections

Introducción: Estudio de la calidad de vida relacionada con la salud (CVRS) en lactantes nacidos prematuros de 32–35 semanas de gestación según su ingreso por infección respiratoria del tracto inferior. Métodos: Estudio transversal anidado en el estudio FLIP-2 sobre 216 progenitores/prematuros de 32–35 semanas, seleccionados concurrentemente en la entrevista final del estudio FLIP-2. Se midió la CVRS del prematuro con la escala QUALIN modificada, la del progenitor se midió con el cuestionario SF-12 y con escalas visuales. Se valoró la sobrecarga del cuidador con escalas directas (Zarit modificada) y medidas indirectas. Se hizo un estudio descriptivo y de asociación multivariante. Resultados: El 33% (71 niños) ingresó por causa respiratoria. Ingresaron significativamente más los nacidos en partos triples y los residentes en hogares con más de 5 habitantes. El 47% de los progenitores de los pacientes ingresados causó baja laboral para atender al niño, frente al 18% del otro grupo. Los padres de los pacientes ingresados tienen mayor sobrecarga y menor puntuación en el componente físico del cuestionario SF-12. El modelo multivariante asocia a la CVRS del prematuro con mayor edad gestacional, tener hermanos de 0–3 años, recibir profilaxis del virus respiratorio sincitial (VRS) cuando está recomendada por tener factores de riesgo, menor sobrecarga del cuidador, mayor CVRS del cuidador en la escala mental del cuestionario SF-12 y no haber perdido jornadas laborales. Conclusiones: Haber ingresado por infección respiratoria no se asocia a diferente CVRS en los prematuros, aunque sí a diferente CVRS y sobrecarga en los cuidadores. La CVRS en los lactantes está asociada a la de sus cuidadores y a su sobrecarga, y a recibir profilaxis del VRS cuando la presencia de factores de riesgo la haría recomendable (AU)

Introduction: Study of the association between lower respiratory tract infection hospitalisations and health related quality of life (HRQoL) in preterm infants of 32–35 weeks of gestational age. Methods: Survey study nested into a prospective follow-up cohort study of preterm infants (FLIP-2). During the last FLIP-2 visit, 216 preterm-parent pairs were interviewed. The structured questionnaire included measures of HRQoL (QUALIN modified scale for the infant, and SF-12 for the parent, and Visual scales for both), caregiver overload (Zarit modified scale and indirect measurements). Results: From October 2006 to March 2007 (RSV season), there were 71 respiratory hospitalisations (33%). Triplets and infants living in homes with >5 inhabitants were most likely to be hospitalised. Parents of hospitalised children were most likely, to have more and longer times off work for child care (47% vs. 18%), to have higher overload, and to obtain lower values in the physical dimension of SF-12. Multiple regression model associated infant HRQoL with higher gestational age, having 0–3 year-old siblings, being recommended palivizumab and had received it, lower caregiver overload, higher caregiver mental HRQoL and no absence from work for child care. Conclusions: Although respiratory hospitalisations were not associated with infant HRQoL, caregivers' HRQoL and overload were. Preterm infant HRQoL is associated with their caregivers' HRQoL and overload, and with receiving RSV prophylaxis when their risk profile recommends it (AU)

[Quality of life of preterm infants and admissions due to respiratory infections]. / Calidad de vida en lactantes nacidos prematuros según ingresos por infección respiratoria.

INTRODUCTION: Study of the association between lower respiratory tract infection hospitalisations and health related quality of life (HRQoL) in preterm infants of 32-35 weeks of gestational age. METHODS: Survey study nested into a prospective follow-up cohort study of preterm infants (FLIP-2). During the last FLIP-2 visit, 216 preterm-parent pairs were interviewed. The structured questionnaire included measures of HRQoL (QUALIN modified scale for the infant, and SF-12 for the parent, and Visual scales for both), caregiver overload (Zarit modified scale and indirect measurements). RESULTS: From October 2006 to March 2007 (RSV season), there were 71 respiratory hospitalisations (33%). Triplets and infants living in homes with >5 inhabitants were most likely to be hospitalised. Parents of hospitalised children were most likely, to have more and longer times off work for child care (47% vs. 18%), to have higher overload, and to obtain lower values in the physical dimension of SF-12. Multiple regression model associated infant HRQoL with higher gestational age, having 0-3 year-old siblings, being recommended palivizumab and had received it, lower caregiver overload, higher caregiver mental HRQoL and no absence from work for child care. CONCLUSIONS: Although respiratory hospitalisations were not associated with infant HRQoL, caregivers' HRQoL and overload were. Preterm infant HRQoL is associated with their caregivers' HRQoL and overload, and with receiving RSV prophylaxis when their risk profile recommends it.

[Methods of investigation in clinical cardiology. VIII. Socioeconomic evaluation of clinical cardiology practice]. / Métodos de investigación en cardiología clínica (VIII). Evaluación socioeconómica de la práctica clínica cardiológica.

Health services are systems whose mission is to improve the health status of both individuals and society in general. In recent decades, these systems have faced challenges such as their increasing complexity, limited resources, rapid innovation and diffusion of medical technologies, pressures on demand from society and professionals, and the lack of knowledge of the effects of these factors on costs and society's health. In addition, health care expenditures have grown twice as fast as wealth in industrialized countries during the last 25 years. These problems have prompted cost containment as a key issue in health policy and, at the same time, have promoted the development of socioeconomic evaluation as a scientific activity in the frame of health services research. Socioeconomic evaluation tries to determine if the sacrifice made by society, which devotes part of its limited resources to health care, maximizes the outcomes for population. This article describes basic concepts and methods of economic appraisal in health services which are illustrated with examples of clinical practice in cardiology. Common methods of evaluation are described; the relation between the clinical outcome of a procedure and its associated costs is emphasized in explaining the types of efficiency analysis (cost-efficacy, cost-effectiveness, cost-utility, and cost-benefit); and finally a guide for socioeconomic evaluation is provided.