[Prevention of thromboembolic disease in patients with heart disease]. / Profilaxis de la enfermedad tromboembólica en enfermos con cardiopatía.

OBJECTIVE: To evaluate the adequacy to thromboembolic disease prophylaxis protocol in patients with heart disease. DESIGN: Cross-sectional study. SUBJECTS: Patients older than 14 years affected of heart disease in a semi-urban health primary-care clinic with a population of 10,610 persons and 5582 clinical records. METHODS: Data about age, sex, cardiovascular risk factors, heart disease, prophylactic treatment and its adequacy to the protocol of the "thromboembolic disease commission" of the reference hospital were analysed. RESULTS: Age 67 +/- 13 years (mean +/- SD). Cardiovascular risk factors: hypertension 40%, diabetes 33%, dyslipemia 15%, smoking 21%. Heart disease: ischemic cardiopathy 48%, atrial fibrillation 15%, valvulopathy 19%, dilated myocardiopathy 4% and other 14%. In 20% of cases had two different affections (80% with atrial fibrillation). Prophylactic therapy: 52% of patients were under prophylactic treatment (35% antiaggregation, 18% anticoagulation). Among antiaggregants, drugs used were acetylsalicylic acid 73.5%, triflusal 14.7%, dipyridamole, 8.8% and ticlopidine 3%. In 53% of people without prophylactic treatment antiaggregation criteria were present. 15% of patient under antiaggregation therapy did not meet antiaggregation criteria, and 6% fulfilled anticoagulation criteria. 67% treatments accorded the reference protocol, without significant differences between kind of heart disease or sex. The only statistically significant difference was found in age: 46% of patients older than 80 year were correctly treated, in front 75% adequacy in younger people. CONCLUSION: Prophylactic antithrombotic therapy was according the reference protocol in 67% of cases. In older patients, with greater risk of thromboembolic disease, the adequacy is worse.

Profilaxis de la enfermedad tromboembólica en enfermos con cardiopatía / Thromboembolic disease prophylaxis in patients with heart disease

Objetivo. Evaluar la adecuación de la profilaxis de la enfermedad tromboembólica en los pacientes diagnosticados de cardiopatía. Diseño. Estudio transversal. Emplazamiento. Área básica de salud semiurbana con una población adscrita de 10.610 habitantes y 5.582 historias clínicas abiertas. Pacientes. Pacientes mayores de 14 años diagnosticados de enfermedad cardíaca (n = 100). Mediciones. Edad, sexo, factores de riesgo cardiovascular, tipo de cardiopatía, tratamiento, y su adecuación a los criterios de la 'comisión de enfermedad tromboembólica' del hospital de referencia. Resultados. Edad media: 67 ñ 13 años. Factores de riesgo: hipertensión, 40 por ciento; diabetes, 33 por ciento; dislipemia, 15 por ciento; tabaquismo, 21 por ciento. Tipos de cardiopatía: cardiopatía isquémica, 48 por ciento; fibrilación auricular aislada, 15 por ciento; valvulopatías, 19 por ciento; miocardiopatía dilatada, 4 por ciento; otras, 14 por ciento. Un 20 por ciento presentaba 2 cardiopatías asociadas (80 por ciento a fibrilación auricular). Seguían tratamiento profiláctico un 52 por ciento de los pacientes (34 por ciento antiagregación, 18 por ciento anticoagulación). Antiagregantes: ácido acetilsalicílico (73,5 por ciento), triflusal (14,7 por ciento), dipiridamol (8,8 por ciento), ticlopidina (3 por ciento). Un 53 por ciento de los casos que no realizaban profilaxis cumplía criterios de antiagregación. El 15 por ciento de los pacientes en tratamiento antiagregante no lo precisaba y un 6 por ciento era candidato a anticoagulación. Se adecuaba al protocolo un 67 por ciento de los casos, sin detectarse diferencias significativas entre distintos tipos de cardiopatías ni sexos. La peor adecuación correspondió a los mayores de 80 años (46 frente a 75 por ciento), diferencia estadísticamente significativa. Conclusiones. La terapia profiláctica antitrombótica se ajusta al protocolo del hospital de referencia en el 67 por ciento de los pacientes. En el anciano, paciente con mayor riesgo de enfermedad tromboembólica, se da la peor adecuación (AU)

Assessing families with a developmentally delayed/handicapped child.

There are many reasons to assess family functioning. The family is the major social force that influences children, and what happens in the family may have more impact on the child's development than the handicap itself. It is essential to inform families of the rationale for a family assessment because they often expect the sole focus to be on the handicapped child. The assessment itself begins with this focus and gradually moves into other areas. If the pediatrician believes family psychotherapy or a support group is indicated, most communities have resources for such services in the public and private sectors.

The neglect and abuse of children and youth: the scope of the problem and the school's role.

We have attempted to define the spectrum of maltreatment of children seen in our current society. The potential for abuse in the child's caretaker, a child who is somewhat different, and a stressful situation are ingredients which often interact to produce maltreatment. The maltreatment rendered to the child includes many mechanisms ranging from direct blows from a variety of objects, to violently shaking the child, to neglect. The spectrum of the pathological findings is as varied as the means to inflict the trauma or neglect and involves every organ system. The predominate pathology of abuse is located in the central nervous system, bones and cutaneous tissues. The school's role primarily involves awareness of the problem of maltreatment, a method of approach to identify and report "suspected" cases, and the documentation of the injuries or neglect which have been observed. The school plays an important role in the follow-up of individual cases in providing a supporting environment for the child and coordinating with other agencies dealing with the family. The school personnel and all professionals must work together if adequate services are to be provided to protect children and rehabilitate families.