[Obstetric risk: evaluation of existing indices and criteria]. / Riesgo obstétrico: evaluación de índices y criterios existentes.

OBJECTIVES: To study the validity of the most common systems for evaluating obstetric risk in a random representative sample of pregnant Andalusian women. DESIGN: Crossover study of 1852 pregnancies of over 28 weeks and in which the women gave birth in the public hospitals of Andalusia (C.I. 95%, 7.5% accuracy). Information came from the maternity and neonatal clinical records and from a home visit after the birth. Sensitivity, specificity and predictive values of each cut suggested by the author in each system evaluated was calculated. Systems were compared with ROC curves. PARTICIPANTS: Andalusian women who gave birth in public hospitals. Measurements and main results. Obstetric risk was evaluated with the Nesbitt and Aubry (ASMI), Hobel, Coopland and IROM indices, with the criteria used in Malaga West District, and Bull's proposals for English general practitioners. The validity of the predictions was studied for premature birth, low birth-weight, the CIR, hypoxia in the new-born, pathological birth and lengthy hospital stays of mother and child. The low predictive power of the indices studied was demonstrated. The best were the Hobel, Coopland and IROM indices. The indices had greater predictive power than the referral criteria: this, appreciating the different philosophies underlying the systems which, independently of their validity, determine the number of pregnant women at risk. CONCLUSIONS: Since defining a pregnant woman as at risk is not innocuous, the research showed the importance of constructing systems, or at least validating existing ones, for the target community.

[The genogram in the evaluation of natural family vital cycle and its dislocations]. / El genograma en la evaluación del ciclo vital familiar natural y de sus dislocaciones.

OBJECTIVES: To evaluate whether the reading of the genogram allows the stages of the family vital cycle (FVC) and the map of relationships to be identified; and to study how it can be used to find the FVC and its dislocations, and family relationships. DESIGN: Descriptive crossover study. SETTING: Primary Care. Health Centres at Almanjayar and Cartuja (Granada). Patients and other participants. 499 genograms performed and analysed by Primary Care doctors. INTERVENTIONS: Reading of the genograms by two doctors who had not participated in taking them, to establish whether the FVC stages and the map of relationships could be identified, and the cycle and its dislocations classified. RESULTS: The reading of the genogram enabled the stages of the FVC to be identified in 96% of cases. 66% of the genograms had the map of relationships correctly drawn. We found that 30% of families were at the fourth stage, 22% in II-B and 19% in II-A. 43% of the genograms contributed data on family relationships. Dislocations in the FVC were evident in 16.6%. CONCLUSIONS: When the genogram is well-constructed, we consider it a good tool for classifying families into the appropriate stage of the FVC, evaluating the role of family interactions throughout the cycle and discovering disruptions in the FVC.

[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.

[The perception of health, social support and family function in HIV seropositivity]. / Percepción de salud, apoyo social y función familiar en VIH positivo.

OBJECTIVE: To discover the perception of health, social support and family function for asymptomatic HIV carriers. DESIGN: This was an observation crossover study, using validated questionnaires. SETTING: Almanjayar and Cartuja Health Centres in Granada. PATIENTS AND OTHER PARTICIPANTS: 58 HIV+ patients belonging to the two basic areas were included. They were selected from the archives of the health centres and from the infectious diseases clinic of the referral hospital. There were an equal number of controls with similar socio-demographic characteristics. MEASUREMENTS AND MAIN RESULTS: The questionnaires used were as follows: GHQ, DUKE-UNC, the family APGAR, which measure health perception, social support and family function, respectively. Of seropositive patients, 58% presented a negative perception of their health, mainly expressed through symptoms of anguish and anxiety; as against 25% of the control group. As to social support, 29% of the HIV+ carriers perceived low levels of support, as against 6.9% of the control group. We found family dysfunction among 46% of seropositive patients, as against 12% of the control group. The Chi squared test was used for the analysis: all the differences were significant. CONCLUSIONS: Patients who are HIV carriers, even when they are asymptomatic, have a poor health perception, which can be attributed to the nature of the illness. The low level of social support detected, linked to the stress involved in being seropositive, may be the origin of the family dysfunction observed in 46% of our sample. We recommend action at individual, family and community levels in order to improve these patients' quality of life, strength their support structures and restore balance to family function.

[The utilization of health services and the motives for consultation as indicators of family dysfunction]. / La utilización de servicios de salud y los motivos de consulta como indicadores de disfunción familiar.

OBJECTIVE: To analyse the relationship between the reasons for seeking care on demand and use of the health services on the one hand and disturbances in the family dynamic, on the other, with an attempt to determine indicators of family dysfunction. DESIGN: Crossover descriptive study where the sample was obtained by systematic sampling. The family APGAR test was applied to the whole sample, along with an analysis of the use of services and the reasons for attendance. SETTING: Almanjayar Health Centre during the first 6 months of 1992. PATIENTS: 356 patients over 18. MEASUREMENTS AND MAIN RESULTS: We confirmed that the likelihood of belonging to a dysfunctional family was 77%, with a risk of 6.5 for hyper and normal users. Regarding reasons for seeking care, those who attended because of ill-defined signs and symptoms are 6.21 times more likely to present a family dysfunction than the rest of those interviewed. Patients with ill-defined symptoms or psychiatric disorders who are hyper-users are 7.20 times more likely to present some family dysfunction. CONCLUSIONS: It will be useful to carry out a study of family function among hyper-users, those who attend because of ill-defined signs and symptoms and people with mental health problems.

[The companion at the clinical interview]. / El acompañante en la entrevista clínica.

OBJECTIVE: To discover how often patients attend a clinical interview with a companion; and to define this companion by the variables of age, gender, reason for the interview, the relationship (friend or relation) and his/her typology. DESIGN: This was a descriptive, prospective study. SETTING: The study was carried out in the Almanjayar and Cartuja Health Centres. PATIENTS AND OTHER PARTICIPANTS: The 899 people who attended for a consultation during the last week of July, 1991, were included in the study. MEASUREMENTS AND MAIN RESULTS: Companions were present in 39.15% of the clinical interviews. Patients under 20 and those with acute complaints were those who most commonly attended with a companion. 94% of the companions were family members: most commonly, the mother or the husband/wife. 18.7% of the companions caused conflict. CONCLUSIONS: The companion can be seen as an important element of the health network as well as a social support. Companions with a collaborative attitude can be used to find out clinical data and family background during the interview; whereas difficult or sick companions require a particular approach to prevent their interfering with the development of the clinical interview.

[The use of role-playing with actors and video in teaching clinical interviews to medical students]. / El rol-play con actores y el vídeo en la enseñanza de la entrevista clínica a estudiantes de medicina.

OBJECTIVE: To describe the use of the technique of role-play, using actors and recorded on video, in teaching clinical interviews to medical students; and the latters' evaluation of the methodology used. DESIGN: Prospective and observational controlled study. SITE. The Faculty of Medicine in Granada. PATIENTS AND OTHER PARTICIPANTS: The study was carried out with a group of 32 students doing the last year of Medicine. MAIN MEASUREMENTS AND RESULTS: Two actors, ten students as interviewers and two teachers were involved. The programme consisted of: a theoretical setting-out of the contents of the clinical interview; a description of the group analysis method; filming simulated interviews on video; group analysis of the material filmed; and evaluation by means of a questionnaire. The choice of interviews gave rise to no problems. The actors assumed with ease the roles they had to play. In the group work, students actively participated and made constructive contributions all the time. In the assessment the items referring to Interest, Teaching Method and Relevance and Originality were high (4.49 out of 5 points). Only that referring to documentation obtained a lower score (3.87 out of 5). CONCLUSIONS: Role-play technique, using actors and video, are excellent educational methods for teaching the clinical interview in undergraduate training.

[A new demographic classification of the family for the use in primary health care]. / Una nueva clasificación demográfica de la familia para su uso en atención primaria de salud.

The approach to the health-disease problem in the family requires a knowledge of demographic features. We propose a demographic classification based on the nuclear family. In addition to the extensive and single-parent families, the lack of family and the familial equivalents we subdivide the nuclear family depending on whether it has close relatives or not, the number of children, the existence of extended family or not, with relatives or aggregates, and the binuclear families or those of divorced people. On this basis, we have evaluated the demographic distribution of 917 families from the basic health areas of Albaicín and Cartuja in Granada, the Valle de Jaén, and Telde in Las Palmas. We have found the predominance of the nuclear family (76.8%) over the extensive (5.2%), as well as the relevance of the single-parent (8.9%) and the lack of family (7.7%) types. Among nuclear families, those with relatives in near areas come first (62.2%), followed by the extended type (19.6%). There is a remarkably low rate of numerous families (9.3%), while binuclear families are exceptional. As familial demography is a factor to be considered in clinical practice owing to its influence in the familial function and resources, we propose the routine use of this classification in the family history.

[Comparative study of the quality of prenatal care at health centers and hospitals]. / Estudio comparativo de la calidad de la atención prenatal entre centros de salud y hospital.

The quality of prenatal care offered in health centers (HC) and in the hospital (H) have been compared. Two samples were evaluated. One consisted of 476 pregnant women seen in HC and another of 213 who were seen in H. Five out of the 22 selected markers did not show differences in both levels (date of delivery; weight gain in g/week; measurement of uterine weight and height; and hypertension detection). Ten markers were better fulfilled in H than in HC (obstetrical formula; gynecological examination, fetal heart beats and edema examination; detection of diabetes, urinary tract infection and anemia). By contrast, there were seven markers that were better fulfilled in HC (serological tests for syphilis and hepatitis B; treatment of urinary tract infection and anemia; and compliance with follow up). The better fulfillment of the markers in H might be due to the recent inclusion of prenatal care programs in HC. The fact that in the first level of care the controls are earlier and more frequent shows that this level facilitates the access of pregnant women to services and their follow up.