Violencia doméstica: preguntar para detectar / Domestic violence: a screening question

ObjetivosEvaluar si preguntas clave permiten detectar la violencia doméstica (VD) y conocer la prevalencia de ésta en atención primaria (AP) y en atención a la mujer (AM).DiseñoEstudio de intervención con asignación aleatorizada.EmplazamientoConsultas de AP y de AM (Sant Boi de Llobregat, Barcelona).ParticipantesSelección sistemática aleatorizada de mujeres en AP (se excluyó a las que se conocía que se las maltrataba) y de mujeres que acudían por primera vez al Servicio de AM. Se seleccionaron controles emparejados por edad. Se entrevistaron 400 mujeres.IntervencionesSe realizó anamnesis y un cuestionario. En el grupo control (GC) había una pregunta referente a VD, en el grupo intervención (GI) se incluían 6 preguntas clave: relación de sus padres, los de la pareja, si la pareja había sufrido maltrato, relación con su pareja, si se consentían las relaciones sexuales y si la pareja se enfadaba cuando no quería tenerlas. Ante VD se preguntaba el tipo, características y duración.ResultadosSe detectaron 101 (25,3%) casos de violencia, 58 (29,4%) en el GI y 43 (21,2%) en el GC (OR [odds ratio] = 1,55; intervalo de confianza (IC): 0,96 a 2,51; p = 0,06). En AM se detectó el 32,7 y el 17,5% (OR = 2,3; IC: 1,2 a 4,5; p = 0,007) y en AP el 25,3 y el 25,8% (OR = 0,97; IC del 95%: 0,47 a 2,02; p = 0,5), respectivamente.ResultadosLas mujeres presentaban características diferentes según la procedencia (AM frente a AP), pero similares entre el GI y el GC, excepto en cuanto a la discapacidad psíquica, que era más frecuente en el GI.ResultadosPresentaba enfermedad psiquiátrica el 23,5%, el 15% de las no maltratadas y el 44% de las maltratadas (de éstas, en el 68% la enfermedad era posterior al maltrato)...(AU)

AimsTo assess whether key questions can detect domestic violence (DV), and find out the prevalence in primary care (PC) and women's care (WC).DesignIntervention Study with random assignment.LocationPC and WC clinics (Sant Boi de Llobregat Barcelona).ParticipantsSystematic random selection of women in PC (not know if battered) and women who came for the first time to the WC service. Age-matched controls were selected. A total of 400 women were interviewed.InterventionsAnamnesis was performed and a questionnaire filled in. In the control group (CG) there was one question concerning DV, in the intervention group (IG) there were 6 key questions: relationship of their parents, partner's parents, if the partner had suffered abuse, relationship with her partner, if sexual relations were consensual or got angry if they were not. When DV was detected, asked about type, features and duration.ResultsA total of 101(25.3%) cases of violence were detected, 58(29.4%) in IG and 43(21.2%) in CG (odds ratio (OR)=1.55, confidence interval (CI): 0.96–2.51, P=0.06). WC rates were 32.7% and 17.5% (OR: 2.3, CI: 1.2–4.5, P:0.007) and PC 25.3% and 25.8% (OR: 0.97, CI: 0.47–2.02, P=0.5), respectively.ResultsDifferent characteristics were observed depending on whether they were from PC or WC, but were similar between IG and CG, except mental disability, more common in IG.Results23.5% suffered from a psychiatric disorder, 15% in non-battered and 44% in the battered, in 68% of these the disorder appeared after the abuse.ConclusionsAbuse is a Public Health problem. When women visit for the first time it is necessary to use indirect questions to make communication easier, if the woman and the professional know each other, a single question is enough to detect it(AU)

[Domestic violence: a screening question]. / Violencia doméstica: preguntar para detectar.

AIMS: To assess whether key questions can detect domestic violence (DV), and find out the prevalence in primary care (PC) and women's care (WC). DESIGN: Intervention Study with random assignment. LOCATION: PC and WC clinics (Sant Boi de Llobregat Barcelona). PARTICIPANTS: Systematic random selection of women in PC (not know if battered) and women who came for the first time to the WC service. Age-matched controls were selected. A total of 400 women were interviewed. INTERVENTIONS: Anamnesis was performed and a questionnaire filled in. In the control group (CG) there was one question concerning DV, in the intervention group (IG) there were 6 key questions: relationship of their parents, partner's parents, if the partner had suffered abuse, relationship with her partner, if sexual relations were consensual or got angry if they were not. When DV was detected, asked about type, features and duration. RESULTS: A total of 101(25.3%) cases of violence were detected, 58(29.4%) in IG and 43(21.2%) in CG (odds ratio (OR)=1.55, confidence interval (CI): 0.96-2.51, P=0.06). WC rates were 32.7% and 17.5% (OR: 2.3, CI: 1.2-4.5, P:0.007) and PC 25.3% and 25.8% (OR: 0.97, CI: 0.47-2.02, P=0.5), respectively. Different characteristics were observed depending on whether they were from PC or WC, but were similar between IG and CG, except mental disability, more common in IG. 23.5% suffered from a psychiatric disorder, 15% in non-battered and 44% in the battered, in 68% of these the disorder appeared after the abuse. CONCLUSIONS: Abuse is a Public Health problem. When women visit for the first time it is necessary to use indirect questions to make communication easier, if the woman and the professional know each other, a single question is enough to detect it.

Disfunción ventricular transitoria o síndrome de Tako-Tsubo / Transient ventricular dysfunction or Tako-Tsubo syndrome

El síndrome de disfunción ventricular transitoria (SDAT) o Tako-Tsubo es una entidad que se presenta en mujeres de mediana edad, sin riesgo cardiovascular elevado, que se caracteriza por un cuadro clínico indicativo de síndrome coronario agudo de causa desconocida desencadenado por una situación de estrés súbito. Se presenta un caso clínico de este síndrome. Mujer de 46 años de edad, atendida de urgencias en su centro de salud por un cuadro de dolor torácico precordial, con cambios electrocardiográficos de lesión subepicárdica encara anterior. En el hospital de referencia, se detectó elevación de los marcadores de daño miocárdico. El cateterismo no mostró lesiones angiográficamente significativas. En la ventriculografía se observó aquinesia apical confracción de eyección disminuida. El resultado de las exploraciones complementarias orientó al diagnóstico de SDAT. El SDAT es una entidad a tener en cuenta en pacientes sin riesgo cardiovascular elevado, dada la diferente implicación pronóstica y de tratamiento (AU)

Transient ventricular dysfunction (TVD) or Tako-Tsubo syndrome is a disorder that occurs in middle aged women with an increased cardiovascular risk. It is characterised by a clinical picture suggestive of acute coronary syndrome of unknown cause, triggered by an acute stress situation. A clinical case of this syndrome is presented. A 46 year old female patient was seen as an emergency in her health centre die to a clinical picture of precordial chest pain with electrocardiography changes of an anterior subepicardiallesion. Increases in the myocardial damage markers were detected in the reference hospital. The angiographic catheter showed significant lesions. Ventriculography showed evidence of apical a kinesia with a decrease dejection fraction. The results of the complementary examinations led to the diagnosis of a transient ventricular dysfunction syndrome TVDS). TVDS is a condition to take into account inpatients who do not have a high cardiovascular risk given the prognostic and treatment implications (AU)

Cumplimiento terapéutico en pacientes con enfermedad cardiovascular / Therapeutic compliance in patients with cardiovascular disease

Introducción. El objetivo del estudio fue analizar el grado y las causas de incumplimiento mediante el test de Morisky-Green y compararlo con el juicio de cada médico de familia del centro de salud. Métodos. Se diseñó un estudio descriptivo transversal. Se realizó una selección aleatoria de 180 pacientes con enfermedad cardiovascular de 580 registrados. Se excluyeron los domiciliarios, los dependientes y los que se negaron a participar en el estudio. Mediante encuesta se recogió: sexo, edad, estudios, episodio cardiovascular y tiempo de evolución, número de diagnósticos y de fármacos y su posología. Se detectaron los no cumplidores con el test de Morisky-Green y se evaluaron las causas. Posteriormente se contrastó con la opinión de cada médico. Resultados. La media de edad fue de 70 años (desviación estándar [DE], 9,7), el 69% varones, el 91% con estudios primarios o analfabetos, el 75% tenía mínimo 4 diagnósticos y el 30% realizaba 10 o más tomas de medicamento diarias. Según el test, el 51% eran cumplidores, cifra similar a la opinión del médico (55%). La concordancia entre ambos fue muy baja (índice kappa = 0,14). La principal causa de incumplimiento fue olvidar las tomas (59%) y la segunda, negarse a depender de la medicación (20,5%). Conclusiones. La mitad de los pacientes era cumplidora según el test y según el juicio clínico del médico de familia, aunque había baja concordancia entre ambos. La principal causa de incumplimiento fue el olvido de la toma y la segunda negarse a depender de la medicación

Introduction. The aim of this study was to investigate the level and main reasons for non-compliance by using Morisky-Green's test. Later, this information was cross-checked with the opinion of the family doctor of each patient. Methods. A cross-sectional descriptive study was designed. 180 patients out of 580 with cardiovascular disease were randomly included. Home-care patients, those dependent and those who refused to be interviewed were excluded. By means of a questionnaire, gender, age, educational level, type of cardiovascular event, number of diagnoses, medication and dosage schedule were studied. Non-compliers were detected by the test and the main reason for non-compliance evaluated. Family doctors were also asked for their opinion. Results. The mean age was 70 years (standard deviation [SD], 9.7), 69% men, 91% with primary school studies or illiterate, 75% had a minimum of 4 diagnoses and 30% took more than 10 medications daily. According to the test, 51% had a good compliance, almost the same percentage when we asked the opinion of their doctor (55%). The concordance between both patient and doctor was very low (index kappa = 0.14). The main cause for non-compliance was forgetfulness (59%) and second was that the patients refused to be dependent on the medication (20.5%). Conclusions. Half of the patients had a good compliance according to the test and agreed with the opinion of their doctor, but there is little agreement between the 2 methods. The main reason for non-compliance was forgetfulness followed by refusing to depend on medication