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Biomedical subjects

J Díez Domingo

Publications and source records attributed to J Díez Domingo.

At least 19 recordsLinked to original sources
PubMed2006

[Incidence and cost of hospitalizations for bronchiolitis and respiratory syncytial virus infections in the autonomous community of Valencia in Spain (2001 and 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.

Bronchiolitis↗
PubMed2006

[Human papillomavirus vaccines: a new challenge for pediatricians].

Human papillomavirus (HPV) infections are the most common sexually transmitted infections in the world. This infection is a necessary cause of cervical cancer, has been related to other forms of anogenital, airway and digestive cancers, and also causes anogenital warts. The recent advances in HPV prophylactic vaccines and their imminent commercial availability will post a new challenge to pediatricians: the indication and administration of these vaccines for the prevention of HPV infection, and consequently, of cervical cancer and other HPV-related diseases. The present article reviews the essentials of HPV infection, its relationship with cervical cancer, the advances in prophylactic HPV vaccines, and the role of the pediatrician in this context.

Adolescent↗
PubMed2003

[Survey of the judicious use of antibiotics in primary care].

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.

Anti-Bacterial Agents↗
PubMed2001

[Use of alternating antipyretics in the treatment of fever in Spain].

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.

Acetaminophen↗
PubMed2000

[Evaluation of the antipyretic safety and accuracy of two pediatric ibuprofen formulations].

AIM: To compare the efficacy and to evaluate the clinical bioequivalence of two different formulations of ibuprofen (suspension and effervescent granules) in febrile children. METHODS: An open, randomized, multicenter study. Febrile children (axillary temperature 38 degrees C) weighing more than 25 kg, admitted into the emergency departments of the participating hospitals were randomly assigned to either of the two treatment groups: ibuprofen suspension (7 mg/kg) or effervescent granules at the following dosages: 200 mg in children weighing 2540 kg or 400mg in children weighing 3540 kg and with an axillary temperature above 39 degrees C. This latter dose of 400 mg was also given to children weighing more than 40 kg.The investigators took axillary temperature before treatment and 30, 60, 90, 120, 180 and 240 min after administration of the corresponding dose. Possible adverse events were noted. RESULTS: A total of 103 patients were included in the study; 51 received the effervescent granules and 52 received the suspension formulation. The mean temperature was reduced in both groups during the study (p < 0.005). No differences were found between the formulations. The mean differences of temperatures at each point of the study were within the clinical bioequivalence interval (+/-0.5 degrees C). Only one patient had an axillary temperature of 35.9 degrees C. This was the only adverse event recorded in the study. CONCLUSIONS: Both ibuprofen formulations were effective in reducing fever and may be considered clinically bioequivalent.

Adolescent↗
PubMed1999

A cost benefit analysis of routine varicella vaccination in Spain.

The objective of the study was to assess varicella epidemiology and the cost of disease in Spain, in order to perform a cost benefit analysis of universal vaccination at 15 months of age. Epidemiological data were obtained from a survey of 150 children with varicella, from hospitalizations and from the Spanish literature. A Markov decision tree was designed with two alternatives, vaccination or nonvaccination. Direct costs derived from the disease were lower than the cost of vaccination (ratio 0.54:1), however when indirect costs, such as working time loss were taken into account, vaccination was the best alternative, with a saving of P(T)2627 per vaccinated subject (P(T)1.6 recovered per peseta invested in the program). Sensitivity analysis shows that decreasing vaccine coverage and efficacy to 0.7, increasing the annual discount rate to 20% and with a vaccine price less than P(T)6000, vaccination is always the best alternative. In conclusion, from the economic point of view, a universal varicella vaccination program in children at 15 months of age would be justified in Spain.

Adult↗
PubMed1999

[Validation of the tympanic thermometer in primary care].

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.

Adolescent↗
PubMed1999

[An analysis of prior antibiotic treatment on the impact of meningococcal disease in children of the Valencian Community. The Study Group of Invasive Diseases].

OBJECTIVE: The objective of this study was to describe the effect of antibiotics given prior to hospitalization of children with meningococcal disease and to assess their relationship with disease outcome and microbiological isolation. PATIENTS AND METHODS: A prospective surveillance system in all hospitals of the Community of Valencia was implemented. All cases of children less than 15 years of age with clinically suspected invasive disease and: 1) N. meningitidis isolated in a normally sterile body fluid; 2) positive capsular antigens in blood or CSF and a positive Gram stain; and 3) clinical diagnosis of an invasive N. meningitidis disease. RESULTS: In a two-year period 157 cases were reported. In 143 cases, data about antibiotic prescription prior to hospitalization was known. Of these, 24.5% had received antibiotics and none had received parenteral penicillin or cephalosporins. Oral antibiotics decreased bacterial isolation (p < 0.001) and did not modify outcome (p = 0.66). CONCLUSIONS: Oral antibiotics, not recommended for N. meningitidis diseases, did not modify prognosis, but decreased bacterial isolation, and therefore worsened clinical handling of the cases and epidemiological studies.

Adolescent↗
PubMed1998

[Vaccination against Haemophilus influenzae type b in the Valencia Community: efficacy and failure of vaccinations].

OBJECTIVE: To study Haemophilus influenzae type b (Hib) conjugate vaccine effectivity and vaccine failures in the Valencian Community of Spain where vaccine can be obtained, but is not scheduled as a routine immunization. PATIENTS AND METHODS: A prospective surveillance system where pediatricians and microbiologists of all public hospitals of the Valencian Community reported cases of invasive Hib disease in children (under 15 years of age). Vaccination status (number of doses, dates and type of vaccine) in each case was obtained. RESULTS: Of 23 cases reported from December 1, 1995 to November 30, 1996, two had received at least one dose of Hib vaccine. One was a true vaccine failure and the other an apparent vaccine failure. Estimating a vaccine coverage of 32.5% of the children less than 5 years old, the direct vaccine effectivity was 90.6% (IC 95%: 27.9-98.8%). CONCLUSIONS: Hib conjugate vaccine is effective in the Valencian Community, however, there is still invasive disease due to the low vaccine coverage and some vaccine failures.

Child, Preschool↗
PubMed1998

[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].

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%.

Chi-Square Distribution↗
PubMed1996

[Modification of the vaccination technique with DTP in nursing infants after 1 intervention].

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.

Diphtheria-Tetanus-Pertussis Vaccine↗
PubMed1995

[Measles seroprevalence in the schoolchildren of Valencia. The Measles Study Group].

BACKGROUND: People born between 1978 and 1982 were the most affected by measles in the outbreaks occurring in the Valencian Community (Spain) in 1993. This age group has not been systematically immunized against measles and has not suffered the last large measles epidemics. HYPOTHESIS: global seroprevalence against measles in this age group is inadequate to prevent new outbreaks. METHODS: Prospective seroepidemiologic study in a sample of school-attending children, born between 1978 and 1982. Randomized sampling of all classrooms 5th to 8th grade high school of a Health Area; stratification depending on the population of the village (< 5,000, 5,001-20,000, > 20,000 inhabitants). Antecedents of measles immunization and the disease were collected. Measles IgG antibodies were measured by enzyme immunoassay, antibody titers 1:80 or higher were considered protective. RESULTS: Sample of 410 subjects, belonging to 17 classes. Measles antibody prevalence was 80.2% (95% CI: 76.6-83.8%), and was higher in less populated villages (p < 0.03). Immunization status was known in 253 subjects (61.7%). Protective titers were present in 86.1% of the vaccinated and in 68.1% of the non vaccinated (p < 0.001). CONCLUSIONS: There is a large percentage of subjects born between 1978 and 1982 unprotected against measles. Elimination of the disease will not be able unless an extraordinary vaccination campaign to include these subjects is taken.

Adolescent↗