[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.

[Survey of the judicious use of antibiotics in primary care]. / Encuesta sobre el uso racional de antibióticos en atención primaria.

OBJECTIVE: To identify pediatricians' antibiotic prescribing habits in acute otitis media and tonsillopharyngitis and to determine the interaction between parents and pediatricians concerning antibiotic use in the Autonomous Community of Valencia (Spain). METHOD: Four hundred members of the Valencian Society of Pediatrics were randomly selected. A semi-structured questionnaire with non-excluding answers was sent by mail and, when responses were not obtained, a second one was sent. The confidentiality of the information was guaranteed. RESULTS: Of 400 questionnaires sent, 143 (35.8 %) were completed; 88.1 % were completed by pediatricians and 51.1 % by primary care workers. A total of 48.3 % of pediatricians used antibiotics in all cases of acute otitis media and 94.5 % prescribed them when fever and otalgia persisted for more than 48 hours. Amoxicillin-clavulanate was the most frequently prescribed antibiotic (63.6 %). Less than 10 % of pediatricians prescribed antibiotics as empirical treatment in tonsillopharyngitis; amoxicillin was the most frequently prescribed antibiotic (54.6 %). Indications for antibiotic treatment were fever, odynophagia and adenomegaly (69.5 %) and tonsillar exudate (62.5 %). Inappropriate antibiotic use was mainly due to excess workload. Providing health education to parents could be the best way of reducing inappropriate use. CONCLUSIONS: Antibiotic use is frequent in the treatment of acute otitis media. Amoxicillin-clavulanate and amoxicillin were the most frequently prescribed antibiotics in tonsillopharyngitis. Providing health education to parents and reducing pediatricians' workload would decrease inappropriate antibiotic use.

Incidencia y costes de la hospitalización por bronquiolitis y de las infecciones / Incidence and cost of hospitalizations for bronchiolitis and respiratory syncytial virus infections in the Autonomous Community of Valencia in Spain (2001 and 2002)

Objetivo Analizar la incidencia y costes de las hospitalizaciones por bronquiolitis y de las infecciones por virus respiratorio sincitial (VRS) en la Comunidad Valenciana. Métodos Análisis de la base de datos de altas hospitalarias (Conjunto Mínimo Básico de Datos, CMBD) de la Comunidad Valenciana de los años 2001 y 2002. Se analizaron las altas hospitalarias con los códigos de bronquiolitis (con o sin determinación etiológica) y las infecciones por VRS ocurridas en niños menores de 2 años. Se eliminaron los casos con más de una hospitalización por bronquiolitis y aquellos casos de infecciones por VRS posiblemente nosocomiales ocurridas durante hospitalizaciones prolongadas. Se estimó un coste medio por día de hospitalización en una sala pediátrica de 310,30 euros. Para el cálculo de incidencia se asumió una cobertura poblacional del CMBD del 95 % y la población según el censo de 2001. Resultados Se obtuvieron 3.705 registros, de los cuales 3.507 fueron bronquiolitis, estando el 42,2 % filiadas como producidas por VRS. La investigación virológica fue diferente según el hospital de ingreso. La hospitalización fue más frecuente entre octubre y abril sin diferencias entre los 2 años. La incidencia de ingreso por bronquiolitis fue de 40,2 casos por 1.000 niños menores de un año y año, y presentó un coste anual medio de 3.618.000 euros. Conclusiones La bronquiolitis tiene un coste hospitalario elevado. La investigación etiológica es baja en algunos hospitales lo que lleva a infraestimar el impacto económico del VRS en la sociedad

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 euros 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

Encuesta sobre el uso racional de antibióticos en atención primaria / Survey of the judicious use of antibiotics in primary care

Objetivo: Conocer los hábitos de prescripción de antibióticos de los pediatras de la Comunidad Valenciana en la otitis media aguda (OMA) y la faringoamigdalitis y la relación padres-pediatra respecto a los antimicrobianos. Método: Se seleccionaron al azar 400 miembros de la Sociedad Valenciana de Pediatría. Cuestionario semiestructurado de respuestas no excluyentes remitido por correo y nuevo envío si no se obtuvo respuesta. Se garantizó la confidencialidad de la información. Resultados De las 400 encuestas remitidas, 143 (35,8 per cent) fueron cumplimentadas. El 88,1 per cent eran pediatras y el 51,1 per cent trabajaban en un equipo de atención primaria. En la OMA, el 48,3 per cent indicaba antibiótico en todos los casos, recetándolo el 94,5 per cent si la fiebre y la otalgia persistían más de 48 h. La amoxicilina-ácido clavulánico fue el antibiótico más prescrito (63,6 per cent). En la faringoamigdalitis, menos del 10 per cent administraban tratamiento empírico, siendo la amoxicilina el antibiótico más utilizado (54,6 per cent). La fiebre, la odinofagia y las adenopatías (69,5 per cent) o el exudado amigdalar (62,5 per cent) fueron los criterios para indicar la antibioticoterapia. El aspecto que más contribuye al uso inapropiado de antibióticos es la presión asistencial y el educar a los padres el que más ayudaría a reducir este uso inapropiado. Conclusiones La utilización de antibióticos en el tratamiento de la OMA es una práctica frecuente. La amoxicilina-ácido clavulánico para la otitis y la amoxicilina en la faringoamigdalitis fueron los antibióticos más prescritos. La educación sanitaria de los padres y reducir la presión asistencial disminuirían el consumo inadecuado de antibióticos (AU)