Gender inequalities in secondary prevention of cardiovascular disease: a scoping review.

BACKGROUND: Despite significant progress in cardiovascular disease (CVD) management, it remains a public health priority and a global challenge. Within the disease process, health care after a cardiovascular event (secondary prevention) is essential to prevent recurrences. Nonetheless, evidence has suggested the existence of gender disparities in CVD management, leaving women in a vulnerable situation. The objective of this study is to identify all available evidence on the existence of gender differences in health care attention after a major adverse cardiovascular event. METHODS: A scoping review following the structure of PRISMA-ScR was conducted. To define the inclusion criteria, we used Joanna Briggs Institute (JBI) population, concept, context framework for scoping reviews. A systematic search was performed in MEDLINE (PubMed), EMBASE and Cochrane. The methods of this review are registered in the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) (INPLASY202350084). RESULTS: The initial search retrieved 3,322 studies. 26 articles were identified manually. After the reviewing process, 93 articles were finally included. The main intervention studied was the pharmacological treatment received (n = 61, 66%), distantly followed by guideline-recommended care (n = 26, 28%) and cardiac rehabilitation (CR) referral (n = 16)". Literature described gender differences in care and management of secondary prevention of CVD. Women were less frequently treated with guideline-recommended medications and seem more likely to be non-adherent. When analysing guideline recommendations, women were more likely to make dietary changes, however, men were more likely to increase physical activity. Studies also showed that women had lower rates of risk factor testing and cholesterol goals attainment. Female sex was associated with lower rates of cardiac rehabilitation referral and participation. CONCLUSIONS: This review allowed us to compile knowledge on the existence of gender inequalities on the secondary prevention of CVD. Additional research is required to delve into various factors influencing therapeutic disparities, referral and non-participation in CR programs, among other aspects, in order to improve existing knowledge about the management and treatment of CVD in men and women. This approach is crucial to ensure the most equitable and effective attention to this issue.

Gender health care inequalities in health crisis: when uncertainty can lead to inequality.

BACKGROUND: In health crisis, inequalities in access to and use of health care services become more evident. The objective of this study is to analyse the existence and evolution of gender inequalities in access to and use of healthcare services in the context of the COVID-19 health crisis. METHODS: Retrospective cohort study using data from all individuals with a confirmed COVID-19 infection from March 2020 to March 2022 in Aragón (Spain) (390,099 cases). Health care access and use was analysed by gender for the different pandemic waves. Univariate and multivariate analyses were conducted to evaluate the effect of sex in health care. Blinder-Oaxaca decomposition methods were performed to explain gender gaps observed. RESULTS: The health care received throughout the COVID-19 pandemic differed between men and women. Women were admitted to hospital and intensive care units less frequently than men and their stays were shorter. Differences observed between men and women narrowed throughout the pandemic, but persisted even after adjusting for age, socioeconomic status, morbidity burden or the patient's place of residence. Differences in sociodemographic characteristics and morbidity burden could explain partially the gender inequalities found, mainly in the later phases of the pandemic, but not in the earlier waves. CONCLUSIONS: There were gender inequalities in access to and use of health services during the COVID-19 pandemic. Inequalities were greater in the first waves of the pandemic, but did not disappear. Analysis of health crises must take into account an intersectional gender perspective to ensure equitable health care.

[Evolution of the presence of women in decision-making bodies of the Spanish national health system]. / Evolución de la presencia de mujeres en los órganos de decisión del Sistema Nacional de Salud en España.

OBJECTIVE: To examine the presence of women in the organs of the Interterritorial Council of the Spanish National Health System (CISNS). METHOD: Annual reports of the CISNS from 2005 to 2022 were analyzed. Artificial intelligence was used to assign gender, and percentages of women's participation were calculated. Temporal evolution, vertical segregation, and horizontal segregation were analyzed. RESULTS: Between 2005 and 2022, there were 14,308 participations in 85 organs, with 52% women, rising from 42% in 2005 to 61% in 2022. There was a higher participation of women in propositional organs (54%), followed by executive ones (50%), and plenary sessions (40%). The General State Administration had 61% women compared to 48% in autonomous communities. Women's participation varied by topic, being higher (82%) in gender violence and lower (35%) in inspection. CONCLUSIONS: Although there is a slight reduction in the participation gap between women and men, inequalities persist. Women have less presence in higher hierarchical levels (plenary sessions), maintaining vertical segregation. Additionally, women's representation in certain topics remains low, maintaining horizontal segregation. Concrete actions must be taken to continue advancing equality and improving health outcomes in society as a whole.

Gaps in sexual health research about women who have sex with women. A scoping review.

OBJECTIVE: To know the characteristics of the studies that have paid attention to women who have sex with women (WSW) and to identify possible gaps in the interest of comprehensive sexual health in WSW. METHOD: A scoping review on sexual health on WSW was conducted from 2000 to 2019. Papers with lack of focus on sexual health on WSW were excluded and a web tool was used to guarantee blindness. Information was extracted on the key characteristics of the studies and the quality of the evidence. The sexual health categories were comprehensive sexual health, specification of sexual practices in WSW, and recommendations provided. RESULTS: 39 studies were included, mostly cross-sectional. The gaps identified were the lack of evidence on sexual health, confusion about sexual orientation and sexual practices, lack of specific interest in comprehensive sexual health and the life cycle approach. Recommendations focused on WSW self-care; interventions aimed at clinical practice, research, education and prevention; and contributions of a feminist approach on sexual health of WSW. CONCLUSIONS: There are several gaps about in the knowledge about sexual health among WSW. Self-care improvement and specific strategies addressed to the unique characteristics of these women and their different and specific situation and health determinants are highlighted.

[Coordination for an affective and sexual diversity approach to monkeypox]. / Coordinación para el abordaje de la viruela del mono con perspectiva de diversidad afectiva y sexual.

In May 2022, the first monkeypox transmission chains were detected outside endemic countries. This outbreak presents clinical and epidemiological characteristics different from those observed in previous outbreaks, with a greater impact among the group of men who have sex with other men. The approach of epidemic outbreaks that requires interventions on communities or populations at risk of stigmatization is a major public health challenge. The independence and professional capacity of scientific societies allow to be take initiatives to provide rapid responses to this type of challenges. Through collaborative work and professional initiative, a document was issued aimed at avoiding stigmatization while promoting the prevention and control measures. For its dissemination, different channels were used counting with key partners. Teamwork, within the participation structures of a scientific society, allows to promote rapid public health actions based on technical recommendations.

[Perception of safety culture in Spanish intensive care units]. / Percepción de la cultura de seguridad en los servicios de medicina intensiva españoles.

BACKGROUND AND OBJECTIVE: Promoting a safety culture in intensive care units (ICUs) is a basic strategy to improve patient safety. The aim of this study was to measure the safety culture in Spanish ICUs. METHOD: We drafted a questionnaire based on the Safety Climate Survey (SCS) and the Safety Attitude Questionnaire-ICU model (SAQ-ICU). A translation-back translation method was employed together with focus group discussions. A questionnaire was designed that analyzed six dimensions: teamwork climate, safety climate, perceptions of management, job satisfaction, working conditions, and stress recognition. The survey was delivered to 22 Spanish ICUs. The results were analyzed to detect strengths and weaknesses in the ICU safety culture. RESULTS: The internal consistency of the survey was 0.92. The response rate was 29.8%. The distribution of positive responses by dimension was as follows: job satisfaction: 65.2%, teamwork climate: 62.1%, safety climate: 50.7%, perceptions of management: 30.3%, working conditions: 43.3%, and stress recognition: 68.8%. Some strengths were detected, such as the percentages who responded affirmatively to the statements "I like my job" (95.1%) and "briefings are important for patient safety" (86.8%). We found significant differences by hospital size: attitudes were better in ICU staff in smaller hospitals than in large hospitals. CONCLUSIONS: The safety culture is poor in Spanish ICUs, but awareness is greater in smaller hospitals. Nevertheless, some strengths were identified, such as communication. Tools to promote free reporting of errors and incident reports should be provided.

[The road to patient safety: facts and desire]. / Circulando hacia la seguridad del paciente: realidad y deseo.

OBJECTIVE: To evaluate differences between the need and degree of implementation of safe practices recommended for patient safety and to check the usefulness of traffic sign iconicity to promote their implementation. METHOD: The study was developed in two stages: 1) review of safe practices recommended by different organizations and 2) a survey to assess the perceptions for the need and implementation of them and the usefulness of signs to improve their implementation. The sample consisted of professionals from Spain and Latin America working in healthcare settings and in the academic field related to patient safety. RESULTS: 365 questionnaires were collected. All safe practices included were considered necessary (mean and lower limit of confidence interval over 3 out of 5 points). However, in six of the patient safety practices evaluated the implementation was considered insufficient: illegible handwriting, medication reconciliation, standardization of communication systems, early warning systems, procedures performed or equipment used only by trained people, and compliance with patient preferences at the end of life. Improve compliance of with hand hygiene and barrier precautions to prevent infections, ensure the correct identification of patients and the use of checklists are the four practices in which more than 75% of respondents found a high degree of consensus on the usefulness of traffic sings to broaden their use. CONCLUSION: The differences between perceived need and actual implementation in some safe practices indicate areas for improvement in patient safety. With this aim, the common language and the iconicity of traffic signs could constitute a simple instrument to improve compliance with safe practices for patient safety.

[Concordance in the registry of dementia among the main sources of clinical information]. / Concordancia del registro de demencia en las principales fuentes de información clínica.

BACKGROUND: The objective of this work was to analyse the concordance in the registry of dementia among the main sources of clinical information, with the aim of determining their usefulness for epidemiological and clinical research. METHODS: Descriptive study of patients assigned to the Aragon Health Service in 2010 (n=1,344,891). DATABASES USED: (i)the pharmacy billing database (n=9,392); (ii)Primary Care electronic health records (EHR) (n=9,471), and (iii)the hospital minimum basic data set (n=3,289). When studying the concordance of the databases, the group of patients with a specific treatment for dementia (i.e., acetylcholinesterase inhibitors and/or memantine) was taken as the reference. RESULTS: The diagnosis in Primary Care was missing for 47.3% of patients taking anti-dementia drugs. The same occurred with 38.3% of dementia patients admitted to hospital during the study year. Among patients with a diagnosis of dementia in the EHR, only half (52.3%) was under treatment for this condition. This percentage decreased to 34.4% in patients with the diagnosis registered in the hospital database. CONCLUSIONS: The weak concordance in the registry of the dementia diagnosis between the main health information systems makes their use and analysis more complex, and supports the need to include all available health data sources in order to gain a global picture of the epidemiological and clinical reality of this health condition.