[A method of detection psychosocial problems at the family physician's office]. / Un método de detección de problemas psicosociales en la consulta del médico de familia.

OBJECTIVE: To find the value of the Stressful Vital Events (SVE) scale for detecting patients with psycho-social problems and how these affect family function. DESIGN: A descriptive, crossover study with systematic sampling. SETTING: Almanjayar Health Centre. PATIENTS AND OTHER PARTICIPANTS: 202 patients (138 women and 64 men) who attended for on-demand consultations at two clinics during October and November 1994. They were selected systematically, 1 from every 5, with under-18s eliminated. INTERVENTIONS: The GHQ, SVE and Family APGAR tests were self-administered. The GHQ test was used to detect psycho-social problems, SVE to measure stressful vital events and the APGAR family to find family function. MEASUREMENTS AND MAIN RESULTS: 46% (94) had psycho-social problems; 53% (107), positive scoring in the SVE test; and 21% (42), family dysfunction. The relationship between SVE and GHQ was significant (p < 0.0001), but relationships with the APGAR weren't. CONCLUSIONS: We consider that exploration of SVEs is a good way of detecting psycho-social problems.

Comparison of intrinsic versus paced ventricular function.

UNLABELLED: There is increasing evidence supporting the benefits of providing optimum AV delay in cardiac pacing, though controversy exists regarding its value and the benefits of intrinsic versus paced ventricular activation. This study compared various AV delays at rest in patients whose native AV delays were > or = 200 msec. Only patients with DDD pacemakers who had intact AV conduction and normal ventricular activation were included in the study. Nine patients were studied. METHODS: Ten studies were performed. Evaluation was done in AAI and DDD modes at paced heart rates of 60/min or as close as possible to the intrinsic heart rate if this was > 60/min. Stroke volume (SV) and cardiac output (CO) were measured. RESULTS: When AV sequential pacing in the DDD mode with an optimum AV delay was compared to AAI pacing with a prolonged AV interval, the average optimum AV delay in the DDD mode was 157 msec and ranged from 125 to 175 msec. The average AV interval in the AAI mode was 245 msec and ranged from 212 to 300 msec. In the DDD mode, there was an overall significant improvement in CO of 11% and SV of 9%. Patients with intrinsic AV conduction times of > 220 msec showed an overall significant improvement in CO of 13% and SV of 11%. In patients with intrinsic AV conduction times of < 220 msec, an improvement in CO of 6% and SV of 4% was seen. CONCLUSIONS: (1) An optimum AV delay is an important component of hemodynamic performance; and (2) AV sequential pacing at rest with an optimum AV delay may provide better hemodynamic performance than atrial pacing with intrinsic ventricular conduction when native AV conduction is prolonged > 220 msec.

Choleretic mechanism and effects of cyclobutyrol in the rat: dose-response relationship.

Although there is general agreement on the hydrocholeretic properties of the so-called "synthetic choleretics" on biliary secretion, related simply to the kinetics of excretion, recent studies suggest that some of these drugs also have a pharmacodynamic effect; mainly, stimulation of bile acid secretion. In the present work, we studied the biliary response to different doses of cyclobutyrol (CB) in order to determine whether this agent stimulates the secretion of bile acids and to establish the relationships between dose and the choleretic effects in anaesthetized rats. Biliary bile flow, sodium, potassium, chloride and bicarbonate outputs were found to be increased and bile acid concentrations reduced in a dose-dependent fashion after 0.40, 0.54, 0.80, 1.08 and 2.16 mmol/kg b.wt. of CB administration. All assayed doses had no effect on the bile acids secretion rate. These findings suggest that a) CB-induced choleresis is unrelated to bile acids; b) CB and bile acids do not compete for the hepatobiliar transport mechanisms, despite the anionic character of both compounds, and c) in the rat the active mechanisms involved in the biliary elimination of CB are not saturated even at the large doses employed.