Influencia de la conciliación familiar y laboral sobre la salud / Influence of the familiar and working conciliation relating to health

Introducción: En el día a día de la atención primaria pediátrica se detectan problemas que pueden estar relacionados con la falta de tiempo de los padres para sus hijos. El objetivo de este trabajo es ofrecer una primera aproximación de cómo afecta la falta de conciliación familiar y laboral a la salud de las familias atendidas. Material y métodos: Estudio multicéntrico, descriptivo, transversal, con muestreo oportunista (n= 203). Los progenitores respondieron voluntariamente a una encuesta, específica según la edad de los niños, sobre las condiciones laborales, la presencia de estrés y el tiempo dedicado a los hijos. Resultados: El 34,98% de la muestra manifiesta estrés percibido como de origen laboral. En un 52,19% de las familias ninguno de los progenitores finaliza su jornada laboral antes de las 17:00 horas. Se halla una relación estadísticamente significativa (p <0,05) entre el horario laboral de los progenitores y la presencia de estrés: finalizar la jornada laboral más tarde de las 17:00 horas aumenta la probabilidad de padecer estrés. Nos e observan relaciones significativas entre la presencia de estrés y el número de visitas al centro. Conclusiones: La incompatibilidad de horarios laborales y escolares actúa como factor de riesgo para la aparición de estrés familiar. La conciliación familiar y laboral es un derecho de las familias y de la sociedad, y su falta puede dañar seriamente la salud de los progenitores y de los hijos. En consecuencia, se deben realizar estudios posteriores para disponer de más datos sobre la forma en que afecta la falta de conciliación familiar y laboral a la salud (AU)

Introduction: On a day-to-day basis of pediatric primary care, some problems, which are detected, may be related to the lack of parents’ time for their children. The aim is to provide a first objective approximation of how the lack of family and working conciliation affects the health of the families cared for. Material and methods: Multicenter, descriptive, transversal studies, with opportunistic sampling (n= 203). Parents voluntarily responded to a survey, specific according to the age of the children, about working conditions, presence of stress, and the time spent with their children. Results: 34.98% of the sample showed stress perceived as of job related origin. In a 52.19% of the families, neither parent’s workday ends before 5:00 pm. There is a statistically significant relation (p <0.05) between the working hours of parents and the presence of stress: when the end of the workday is later than 5:00 pm, the possibility of stress is increased. No significant relationship was observed between the presence of stress and number of visits to the center. Conclusions: The incompatibility of work and school schedules acts as a risk factor in the occurrence of family stress. Reconciling work and family is a right of families and society, and its absence can seriously damage the health of parents and children. Therefore, further studies should be performed to yield more data on how the lack of family and working conciliation affects on the health (AU)

ECG spectral and morphological parameters reviewed and updated to detect adult and paediatric life-threatening arrhythmia.

Since the International Liaison Committee on Resuscitation approved the use of automated external defibrillators (AEDs) in children, efforts have been made to adapt AED algorithms designed for adult patients to detect paediatric ventricular arrhythmias accurately. In this study, we assess the performance of two spectral (A(2) and VFleak) and two morphological parameters (TCI and CM) for the detection of lethal ventricular arrhythmias using an American Heart Association (AHA) compliant database that includes adult and paediatric arrhythmias. Our objective was to evaluate how those parameters can be optimally adjusted to discriminate shockable from nonshockable rhythms in adult and paediatric patients. A total of 1473 records were analysed: 751 from 387 paediatric patients ( 0.01) between the adult and paediatric patients for the shockable records; the differences for nonshockable records however were significant. Still, these parameters maintained the discrimination power when paediatric rhythms were included. A single threshold could be adjusted to obtain sensitivities and specificities above the AHA goals for the complete database. The sensitivities for ventricular fibrillation (VF) and ventricular tachycardia (VT) were 91.1% and 96.6% for VFleak, and 90.3% and 99.3% for A(2). The specificities for normal sinus rhythm (NSR) and other nonshockable rhythms were 99.5% and 96.3% for VFleak, and 99.0% and 97.7% for A(2). On the other hand, the morphological parameters showed significant differences between the adult and paediatric patients, particularly for the nonshockable records, because of the faster heart rates of the paediatric rhythms. Their performance clearly degraded with paediatric rhythms. Using a single threshold, the sensitivities and specificities were below the AHA goals, particularly VT sensitivity (60.4% for TCI and 65.8% for CM) and the specificity for other nonshockable rhythms (51.7% for TCI and 34.5% for CM). The specificities, particularly for the adult case, improve when the thresholds are independently adjusted for each adult and paediatric database.

Brugada syndrome in a patient with accessory pathway.

Brugada syndrome in a patient with Wolff-Parkinson-White syndrome. We report a 32-year-old man with orthodromic atrioventricular (AV) reciprocating tachycardia using a right posterior accessory pathway. However, his ECG showed ST segment elevation in leads V1 to V3. After successful radiofrequency ablation of his accessory pathway a cardioverter defibrillator was implanted.

Prognosis of patients with a first episode of sustained monomorphic ventricular tachycardia.

AIMS: To evaluate the cardiac mortality in patients suffering from a first episode of sustained monomorphic ventricular tachycardia (SMVT). METHODS: 100 patients less than 75 years old were evaluated during a 50-month follow-up period. Patients were classified into four groups: myocardial infarction, dilated cardiomyopathy, normal heart and miscellany. Seventeen patients underwent a cardioverter-defibrillator implantation, two heart transplant, three aneurysmectomy and 10 other types of cardiac surgical proceedings. RESULTS: Patients with a left ventricle ejection fraction (EF)> or =50% presented a cardiac mortality of 5% compared with 38% of those with EF<50%. Etiology of underlying cardiomyopathy with an EF> or =50% was associated with a cardiac mortality of 5% (normal heart), 5% (myocardial infarction) and 9% (miscellany) compared to those with EF<50%: 33% (dilated cardiomyopathy) and 40% (myocardial infarction). Patients who experienced syncope during the first episode of SMVT showed a cardiac mortality of 31% compared to those 14% (P < 0.05) who did not experience. Patients with syncope, myocardial infarction and EF<50% showed a cardiac mortality of 68%. CONCLUSION: The present study shows that survival after the first episode of SMVT is closely related to EF and the existence of syncope. Patients with myocardial infarction and EF<50% had a worse prognosis when the site was the inferior wall.

[Exercise-induced atrioventricular block. Significance of the ischemic component. Report of 4 new cases]. / Bloqueo auriculoventricular inducido por el esfuerzo. Importancia del componente isquémico. Presentación de cuatro nuevos casos.

We report four new cases of exercise-induced atrio-ventricular block (appearing during treadmill exercise testing). The mechanism was ischemia in two patients and the conduction disturbance disappeared after coronary artery bypass grafting. The literature on this matter is reviewed. Also the etiology, the natural history and management are discussed in these cases.

[The efficacy of verapamil in sustained monomorphic ventricular tachycardia]. / Eficacia del verapamilo en la taquicardia ventricular monomorfa sostenida.

We present a 36-year-old male without overt cardiac disease who suffered, since he was 15 years old, from sustained monomorphic ventricular tachycardia of left bundle branch block with a right axis, lasting for several hours; sometimes, syncope was a clinical form of manifestation. Electrophysiologic study, twenty-four hours Holter recording, cardiac catheterization and blood analysis were not useful in order to find its etiology. Efficacy of different drugs, like Mexiletil, Amiodarone, Atenolol and Verapamil (at a dose of 240 mg/day) were tested through multistaged graded-treadmill stress-testing using the Bruce protocol. Ventricular tachycardia was suppressed by administration of Lidocaine. Oral verapamil given at a dose of 360 mg/day prevented the induction of the arrhythmia, the efficacy was tested with maximal treadmill exercise and twenty-four hours Holter recording.

Conversion of atrial fibrillation with ajmaline in a pregnant woman with Wolff-Parkinson-White syndrome.

Pregnancy is related to an increased frequency of arrhythmias in asymptomatic patients with Wolff-Parkinson-White syndrome, which might lead to sudden death. A 40-year-old woman, with Wolff-Parkinson-White syndrome which was not diagnosed until pregnancy, presented in the 34th week with an atrial fibrillation, with high risk criteria for ventricular fibrillation. Intravenous ajmaline was given to convert the tachyarrhythmia to sinus rhythm. We obtained an excellent maternal control with no maternal or fetal adverse effects.

[Propafenone efficacy in preventing supraventricular tachycardia in childhood]. / Eficacia de la propafenona en la prevención de la taquicardia supraventricular en la infancia.

OBJECTIVES: In order to study the efficiency of oral dose of propafenone in preventing childhood supraventricular tachycardias, we have treated 38 children without left ventricular dysfunction. METHODS: The mean age has been 8 +/- 4.7 years old. All of them had suffered at least two episodes of supraventricular tachycardia, and eleven had undergone a previous antiarrhythmic treatment. The initial dose of propafenone has been 6.5 +/- 2.1 mg/kg/24 h (in 3 doses), which has been increased in case of inefficacy. RESULTS: We have not advised neither side-effects, nor proarrhythmic effects, during a follow-up of 13 +/- 6 months. Propafenone has been efficient in preventing supraventricular tachycardias in all patients. The initial dose has been efficient in 17 patients, and we have increased the initial dose up to 11.1 +/- 3.7 mg/kg/24 h in 21 patients. The mean effective dose has been 8.9 +/- 3.6 mg/kg/24 h. We stopped treatment in 14 patients after been 6 months without supraventricular tachycardias. CONCLUSION: From our study, we conclude that propafenone has been efficient in preventing supraventricular tachycardias in childhood with a dose of 8.9 mg/kg/24 h. We have not found side-effects.

[The surgical section of the bundle of Kent as an operative treatment of the Wolff-Parkinson-White syndrome: apropos a series of 82 operated cases]. / Sección quirúrgica del fascículo de Kent como tratamiento cruento del síndrome de Wolff-Parkinson-White: a propósito de una serie de 82 casos operados.

Eighty two patients diagnosed of the Wolff-Parkinson-White syndrome (WPW) underwent operation for the surgical section of the Kent-His bundle. In these cases, posteroseptal localization (PS) occurred in 32, left lateral (LL) in 25, right lateral (RL) in six, anteroseptal (AS) in one, posteroseptal and left lateral in 14, right and left posteroseptal in two, anteroseptal and left lateral in one, and left lateral and right and left posteroseptal in one. All of the patients presented an invalidating clinical of palpitations and/or loss of consciousness, and episodes of atrial fibrillation and/or reciprocal rhythm were registered in all cases. The mean anterograde refractory period in the accessory pathways was 244 +/- 60 msec, and the shortest RR in atrial fibrillation was 190 +/- 36 msec. A mitral commissurotomy was carried out in 3 patients during surgery, mitral prostheses were implanted in two, a double aorto-coronary bypass was made in three and an interventricular communication was closed in one. After a follow-up of 36 +/- 18 months, the surgical section of the Kent bundle was found to be effective in 77 out 82 patients (94%). (In 70 out of 77 cases, both anterograde and retrograde conduction were totally abolished and in seven out of 77 obtunded. All patients were asymptomatic during the follow-up period). In 5 out of 82 patients, surgical treatment was ineffective all five showed a PS Kent-His and two presented a second Kent-His fascicle (LL).(ABSTRACT TRUNCATED AT 250 WORDS)

[Prognostic factors for success in catheter ablation of the right Kent bundle: report of 27 patients]. / Factores pronóstico de éxito en la fulguración de los haces de Kent derechos: a propósito de una serie de 27 pacientes.

In 27 patients with atrial fibrillation and/or reciprocating tachycardia, ablation of right-sided Kent bundles (23 in the right posterior paraseptal region and four of the right free wall) was performed. The anterograde refractory period of the accessory pathways was 253 +/- 70 msec and the shortest R-R interval during atrial fibrillation 211 +/- 47 msec. Cumulative energies of 589 +/- 396 J per patient were used, with 3 +/- 2 shocks and 195 +/- 312 J per shock. Accessory pathway ablation was effective in 16/27 patients (59%) during an 11 +/- 8 months of follow-up (in 15/16 pre-excitation disappeared; in nine of them the anterograde and retrograde conductions were abolished and in the other six the anterograde and retrograde conductions were severely altered; ablation was partially ineffective in 1/16 patients who remained asymptomatic on medical treatment and without inducible reciprocal rhythm). Ablation was ineffective in 11/27 patients. Three hours after ablation a patient died from electromechanical dissociation; during ablation a 200 J shock cancelled preexcitation, not being possible to produce reciprocal rhythm. The emergency echocardiography only showed a minimum posterior pericardial effusion. Ablation was effective in 15/23 patients (65%) right posterior paraseptal. Overall success in 1989 (10/27 patients) was 70% (7/10 patients). The success in 1989 was 70% (6/8 patients) right posterior paraseptal. The shortest RP' interval (was 82 +/- 19 msec) during the reciprocal rhythm, where the ablation was performed, was 82 +/- 19 msec (74 +/- 17 msec with success and 99 +/- 19 msec with failure).(ABSTRACT TRUNCATED AT 250 WORDS)