[The necessary response of health services to gender violence. Comprehensive care and provision of integrated services]. / La respuesta necesaria de los servicios de salud ante la violencia de género. Atención integral y prestación de servicios integrados.

Gender violence has multiple and serious consequences for the health of victims and their families, hence the reason for the important role that the health system plays in addressing it. Health professionals have a key role in the response, which must include early detection, care, and follow-up; actions in which primary care, because of its privileged position in the system, can play a fundamental part. This article establishes the necessary characteristics for the intervention to be effective: comprehensive care, multidisciplinary approach, intersectoral coordination, and integrated service provision; all of it community-oriented, person-centered, and adapted to its context (social factors and vulnerabilities) with an intersectional approach. The woman, her sons and daughters, and other cohabitants, as well as the perpetrator, are considered the object of intervention in the response, and specific guidelines for action are provided for detection, care, and follow-up. Reorientation of interventions, with emphasis on a community approach, is also proposed.

[Impact of care for victims of gender violence on the health professionals]. / Impacto de la atención a las víctimas de violencia de género en los y las profesionales de la salud.

Professionals who work with women victims of gender violence face difficult emotional situations, and it is important to be aware of the emotions and feelings that the attitudes and behaviour of victims and aggressors generate in them. These emotions can become barriers to communication and seriously affect the professional's relationship with victims. Furthermore, they can generate situations of sustained stress, lead to emotional exhaustion, and affect their health, life, and work performance. We describe the consequences, risk factors and warning signs, as well as protective or resilience factors, that are important to know, and we list the current challenges and some recommendations for professionals and management in order to help prevent such effects and improve professional performance without health risks.

[Health consequences of violence against women by the couple]. / Consecuencias para la salud de la violencia contra la mujer por la pareja.

Intimate partner violence against women (IPV) has devastating effects on the healthcare and well-being of women and their children. Physical, psychological, and social consequences, a worse perception of their own health, and loss of quality of life are well-documented, while aftereffects persist in time even after the end of abuse. Psychological consequences of abuse last longer and are more serious. IPV also affects sons and daughters, disabled people, family, and the attacker himself. Many health problems, both physical and mental, that lead women to go to healthcare services in search of help have an origin in the violence they experience. Treatment of the symptoms without awareness of its relation to such violence favours medicalization, iatrogenesis, and chronification. Psychological violence poses a threat that is invisible, subtle, cumulative, and difficult to detect; it is, however, the most destructive.

Trends in COVID-19-related in-hospital mortality in women and men.

INTRODUCTION: Whether political, scientific and medical development in a country is associated with better clinical results according to gender in patients with COVID-19 has not yet been clearly elucidated. OBJECTIVE: To determine the trends of COVID-19-related in-hospital mortality in women and men from March 2020 to February 2022. METHODS: Clinical data of all patients with COVID-19 cared for at 21 Spanish hospitals were used, both of those who were discharged and of those who died during hospitalization. The association between hospital length of stay and mortality was analyzed with logistic regression models. RESULTS: Out of 7,974 patients that were included, 3,234 were women; 928 patients died. A significant decreasing trend in mortality was identified. When the analysis was carried out by gender, no significant mortality trend was found in women (OR = 0.96 [0.90-1.03], p = 0.239), while in men there was a significant decreasing trend identified (OR = 0.87 [0.82-0.92], p < 0.001). CONCLUSION: Health policies, together with clinical and preventive interventions, may explain these results. Response to treatment and behavioral differences may explain why mortality does not decrease for women.

INTRODUCCIÓN: Todavía no se comprende si el desarrollo político, científico y médico en un país se asocia a mejores resultados clínicos de los pacientes con COVID-19 según el sexo. OBJETIVO: Determinar las tendencias de mortalidad hospitalaria asociada a COVID-19 en mujeres y hombres entre marzo de 2020 y febrero de 2022. MÉTODOS: Se utilizaron los datos clínicos de todos los pacientes con COVID-19 atendidos en 21 hospitales españoles, tanto de quienes fueron dados de alta como de quienes fallecieron durante el ingreso. La asociación entre la fecha del ingreso y la mortalidad se analizó con modelos de regresión logística. RESULTADOS: Fueron incluidos 7974 pacientes, de los cuales 3234 fueron mujeres y 928 fallecieron. Se encontró una tendencia significativa y decreciente en la mortalidad según avanzaba la fecha del ingreso. Cuando el análisis se realizó por sexos, no se halló una tendencia significativa en las mujeres (RM = 0.96 [0.90-1.03], p = 0.239), pero sí en los hombres (RM = 0.87 [0.82-0.92], p < 0.001). CONCLUSIÓN: Las políticas de salud, junto con las intervenciones clínicas y preventivas, pueden dar cuenta de los resultados. Diferencias en la respuesta al tratamiento o en los comportamientos pueden explicar por qué la mortalidad no disminuye en las mujeres.

[Benefits of a community physical exercise program prescribed from primary care for perimenopausal/menopausal women]. / Beneficios de un programa de ejercicio físico comunitario prescrito desde Atención Primaria en la salud de mujeres perimenopáusicas/menopaúsicas.

OBJECTIVE: To measure the benefits of a physical exercise program in a community, through the modifications in quality of life, and perimenopausal-menopausal women physical condition. SETTING: The participants were recruited in PC consultations from two health centers in Molina de Segura (Murcia). PARTICIPANTS: Women between 40 and 70 years old, or under 40 of age diagnosed with early menopause. DESIGN: Quasi-experimental study, non-randomized, controlled, open and single-center with 2 parallel branches to study. INTERVENTION: Experimental group: ACTIVA Bone Health Program for six months. CONTROL: inactive. MAIN MEASUREMENTS IN BOTH GROUPS: The SF 36 questionnaire was used to measure the Quality of life. PHYSICAL CONDITION: Aerobic condition, flexibility, balance and strength measured with the mile, flamenco, flexibility box tests, and throwing the medicine ball, respectively. Physical activity level through the GPPAQ Questionnaire. Sociodemographic variables were collected and the adherence to the program was measured. RESULTS: The quality of life improved in the intervention group compared to the control group, except «Body Pain¼ dimension (p = 0.412). As regards the intragroup level, all dimensions showed significant improvement except both «Physical Function¼ (p = 0.263) and «Body Pain¼ (p = 0.136). The physical capacities that benefited most were aerobic fitness, strength and balance. CONCLUSIONS: The Active Bone Health Physical Exercise Program piloting showed benefits on participants' physical and mental quality of life. In addition, it has been shown that performing a specific physical exercise for premenopausal-menopausal women improves their physical condition.

Gender and age-related variations in human immunodeficiency virus infection trends at the Mexican Institute of Social Security: 2003-2017.

INTRODUCTION: Diagnosing and treating human immunodeficiency virus carriers has led to the identification of a higher prevalence of said infection and, therefore, of a higher risk of transmission of the virus. OBJECTIVE: To find out the trend of new cases of human immunodeficiency virus infection carriers at the Instituto Mexicano del Seguro Social (IMSS) in Mexico within the 2003-2017 period. METHODS: Patients affiliated to the IMSS were analyzed. Data from 42,181 newly-diagnosed cases were collected, with variations related to gender and age being observed. Age-standardized rates per 100,000 population were obtained. RESULTS: The highest mean annual percentage change in males was documented in adolescents (13.0, 95% CI = 9.9, 16.1). Heterogeneous trends were recorded for women, with a significant overall decrease (-2.2, 95% CI = -3.4, -1.0), but growing trends were also observed in some groups. CONCLUSIONS: Our results suggest that the human immunodeficiency epidemic in patients cared for at the Instituto Mexicano del Seguro Social is concentrated in males, with a growing trend particularly in adolescents.

INTRODUCCIÓN: Hacer el diagnóstico y tratar a portadores del virus de la inmunodeficiencia humana ha llevado a identificar mayor prevalencia de esa infección y, por lo tanto, de un mayor riesgo de transmisión de este virus. OBJETIVO: Conocer la tendencia en México de los nuevos casos de portadores de infección por el virus de la inmunodeficiencia humana en el Instituto Mexicano del Seguro Social (IMSS) en el periodo 2003-2017. MÉTODOS: Se analizaron pacientes asegurados en el IMSS. Se obtuvieron datos de 42 181 casos recién diagnosticados y se analizaron las variaciones relacionadas con el sexo y la edad. Se obtuvieron las tasas estandarizadas por edad por 100 000 personas. RESULTADOS: El cambio porcentual anual promedio más alto en hombres se documentó en adolescentes varones (13.0, IC 95 % = 9.9, 16.1). Se registraron tendencias heterogéneas en las mujeres, con una disminución total significativa (­2.2, IC 95 % = ­3.4, ­1.0), pero también se observaron tendencias crecientes en algunos grupos. CONCLUSIONES: Los resultados sugieren que en el IMSS, la epidemia de la inmunodeficiencia humana adquirida se concentra en hombres, con tendencia creciente particularmente en adolescentes.

Impact of a prenatal education intervention in pregnant women to prevent overweight in infants.

INTRODUCTION: During the first 1000 days of life is the basis for a child's future health established. OBJECTIVE: To evaluate the impact of a prenatal educational intervention in pregnant women on the nutritional status of the child from birth to 4 months of age. METHODS: Quasi-experimental intervention design in women with at least 12 weeks of gestation, who were randomly assigned to an intervention group (IG) to participate in five group and three individual sessions on feeding practices and maternal perception of the child's weight and signals of hunger-satiety; the control group (CG) received routine care that included at least three prenatal consultations. RESULTS: Thirty women were included in each group. After the intervention, women in the CG practiced less exclusive breastfeeding, were more likely to underestimate or overestimate the children's weight, and perceived hunger-satiety signals with less intensity (p < 0.05). 80 % of the infants in the IG had normal weight, whereas 63 % of those in the CG had a combination of overweight and obesity (p < 0.05). CONCLUSIONS: The prenatal education program in pregnant women showed a significant effect on postnatal nutritional status of infants four months after birth.

INTRODUCCIÓN: Durante los primeros 1000 días de vida se establece la base para la salud futura de un niño. OBJETIVO: Evaluar el impacto de una intervención educativa prenatal en mujeres embarazadas sobre el estado nutricional del hijo desde el nacimiento hasta los cuatro meses de edad. MÉTODOS: Diseño cuasiexperimental de intervención con mujeres a partir de la semana 12 de gestación, asignadas aleatoriamente a un grupo de intervención (GI) para recibir cinco sesiones grupales y tres individuales sobre prácticas de alimentación y percepción materna del peso del hijo y de señales de hambre-saciedad; el grupo control (GC) recibió atención de rutina que incluía al menos tres consultas prenatales. RESULTADOS: 30 mujeres conformaron cada grupo. Después de la intervención, las mujeres del GC practicaron menos lactancia materna exclusiva, fueron propensas a subestimar o sobrestimar el peso del hijo y percibieron con menor intensidad las señales de hambre-saciedad (p < 0.05). El 80 % de los lactantes del GI presentaron peso normal y 63 % de los niños del GC, una combinación de sobrepeso y obesidad (p < 0.05). CONCLUSIONES: El programa de educación prenatal en mujeres embarazadas mostró un efecto significativo en el estado nutricional de los lactantes después de cuatro meses del nacimiento.

General practitioners' knowledge about pregnancy complications associated with long-term cardiovascular risk.

INTRODUCTION: Cardiovascular disease (CVD) is the leading cause of mortality in women; preeclampsia (PE) and gestational diabetes mellitus (GDM) are associated with an increased risk of CVD. OBJECTIVE: To evaluate general practitioners (GP) knowledge about complicated pregnancies and their association with CVD. METHODS: An anonymous case-based electronic questionnaire designed to assess the level of understanding on the influence of a history of pregnancy complications on long-term cardiovascular risk and general knowledge about CVD risk was sent to GPs. RESULTS: The response rate was 35 % (161/465). The participants recognized that PE and GDM are risk factors for CVD (98 and 83 %, respectively), and reported the following CVD screening strategies in women with a history of PE and GDM: blood pressure monitoring (PE 100 %, GDM 46 %), body mass index calculation (PE 68 %, GDM 57 %), lipid profile evaluation (PE 71 %, GDM 57 %), glycated hemoglobin (PE 26 %, GDM 92 %), and fasting glucose (PE 28 %, GDM 91 %). CONCLUSION: GP-reported screening strategies to identify CVD in women with a history of PE and GDM were variable.

INTRODUCCIÓN: La enfermedad cardiovascular (ECV) constituye la principal causa de mortalidad en mujeres; la preeclampsia (PE) y la diabetes mellitus gestacional (DMG) están asociadas a incremento en el riesgo de ECV. OBJETIVO: Evaluar el conocimiento de los médicos generales (MG) sobre complicaciones obstétricas asociadas a ECV. MÉTODOS: Se envió a los MG un cuestionario electrónico anónimo basado en casos, diseñado para evaluar el entendimiento de la influencia de la historia obstétrica en el riesgo cardiovascular a largo plazo y el conocimiento general sobre riesgo de ECV. RESULTADOS: La tasa de respuesta fue de 35 % (161/465). Los participantes reconocieron que la PE y la DMG son factores de riesgo para ECV (98 y 83 %, respectivamente) y reportaron las siguientes estrategias de tamizaje de ECV en mujeres con historial de PE y DMG: monitoreo de presión arterial (PE 100 %, DMG 46 %), cálculo de índice de masa corporal (PE 68 %, DMG 57 %), evaluación del perfil de lípidos (PE 71 %, DMG 57 %), hemoglobina glucosilada (PE 26 %, DMG 92 %) y glucosa en ayuno (PE 28 %, DMG 91 %). CONCLUSIÓN: Las estrategias de tamizaje para identificar ECV en mujeres con antecedentes de PE y DMG reportadas por los MG fueron variables.

Violence against women in Primary Health Care: Potentialities and limitations to identification.

OBJECTIVE: To determine the potential and limitations of Primary Health Care professionals to identify situations of violence against women. LOCATION: A municipality of Rio Grande do Sul, Brazil. DESIGN: Descriptive and exploratory study with a qualitative approach. PARTICIPANTS: Twenty-one health professionals of three Family Health Strategy units, as well as one Basic Health Unit. The inclusion criterion consisted of being a health worker in these services. The exclusion criterion was to be absent from work by any kind type license during the period of data production. METHOD: The technique used to produce data was individual, semi-structured, interviews in order to collect sociodemographic data and the monitoring by professionals related to the potentials and limitations to identify violence situations. The data collection was suspended based on the saturation criterion. The data were systematized and analyzed by the content analysis technique, according to the analytical categories of health care network and gender. RESULTS: The potential to identify themes were: professional experience, receptive atmosphere, bonding, and listening to the reports of women, children and/or neighbors and observing their behavior; to identify the lesions; prenatal consultations; and home visits. As to the limitations: silence, denial/non-recognition of violence, lack of complaints by women; fear and guilt; flaws and unpreparedness of the health team; and fear due to the presence of aggressor. CONCLUSIONS: It is urgent to recognize the potential of Primary Care and to promote the qualification of professionals in order to identify the situation among visible and invisible complaints, leading to the confrontation of violence.

Effects training in hypoxia on cardiometabolic parameters in obese people: A systematic review of randomized controlled trial.

OBJECTIVE: The aim of the present review is to evaluate effects of intermittent hypoxia and exercise therapy in cardiometabolic parameters on adult obese people. DATABASE: Three well-known databases were selected: EMBASE, MEDLINE and Web of Science. Studies selection: Inclusion criteria were: (a) human healthy overweight or obese adults, (b) study randomized controlled trial, (c) original experimental study, (d) English languages and (e) therapy with intermittent hypoxia and exercise. DESIGN: The assessment of the methodological quality of each study was based upon the risk of bias (PEDro scale) and level of evidence (CBO Guidelines). DATA EXTRACTION: five articles clearly met inclusion criteria and were reviewed to data extraction. RESULTS: In the hypoxia groups, weight, body mass index, waist circumference, waist-hip ratio, fat mass and lean mass improved in at least two studies in comparison with the baseline. Systolic blood pressure improved in one study. The lipid profile and the aerobic capacity were not reduced significantly. CONCLUSIONS: Results suggest that combined hypoxia with exercise may help to improve cardiometabolic parameters in obese people.

Retention in care of HIV-infected pregnant and lactating women starting ART under Option B+ in rural Mozambique.

OBJECTIVE: In 2013, Mozambique adopted Option B+, universal lifelong antiretroviral therapy (ART) for all pregnant and lactating women, as national strategy for prevention of mother-to-child transmission of HIV. We analysed retention in care of pregnant and lactating women starting Option B+ in rural northern Mozambique. METHODS: We compared ART outcomes in pregnant ('B+ pregnant'), lactating ('B+ lactating') and non-pregnant non-lactating women of childbearing age starting ART according to clinical and/or immunological criteria ('own health') between July 2013 and June 2014. Lost to follow-up was defined as no contact >180 days after the last visit. Multivariable competing risk models were adjusted for type of facility (type 1 vs. peripheral type 2 health centre), age, WHO stage and time from HIV diagnosis to ART. RESULTS: Over 333 person-years of follow-up (243 'B+ pregnant', 65'B+ lactating' and 317 'own health' women), 3.7% of women died and 48.5% were lost to follow-up. 'B+ pregnant' and 'B+ lactating' women were more likely to be lost in the first year (57% vs. 56.9% vs. 31.6%; P < 0.001) and to have no follow-up after the first visit (42.4% vs. 29.2% vs. 16.4%; P < 0.001) than 'own health' women. In adjusted analyses, risk of being lost to follow-up was higher in 'B+ pregnant' (adjusted subhazard ratio [asHR]: 2.77; 95% CI: 2.18-3.50; P < 0.001) and 'B+ lactating' (asHR: 1.94; 95% CI: 1.37-2.74; P < 0.001). Type 2 health centre was the only additional significant risk factor for loss to follow-up. CONCLUSIONS: Retention among PLW starting option B+ ART was poor and mainly driven by early losses. The success of Option B+ for prevention of mother-to-child transmission of HIV in rural settings with weak health systems will depend on specific improvements in counselling and retention measures, especially at the beginning of treatment.

PARTNER INVOLVEMENT: NEGOTIATING THE PRESENCE OF PARTNERS IN PSYCHOSOCIAL ASSESSMENT AS CONDUCTED BY MIDWIVES AND CHILD AND FAMILY HEALTH NURSES.

Universal screening for maternal depression and assessment of psychosocial risks has been integrated into the routine perinatal care provided in many Australian hospitals, but to date, partners/fathers have been largely excluded from the process. This study explored the ways in which clinicians in health service settings include partners who attend antenatal and postnatal visits with women. Qualitative data were collected using observations (n = 54), interviews (n = 60), and discussion groups (n = 7) with midwives and child and family health nurses who conducted the appointments. Transcripts from observations, interviews, and discussion groups underwent qualitative analysis, and key themes were identified. Results showed partners to have little or no involvement in psychosocial assessment and depression screening. Thematic analysis revealed four key themes: negotiating partner exclusion, partial inclusion, women's business or a couple concern? and they know anyway. Partner involvement appeared to be challenged particularly by mandatory interpersonal violence screening, which, according to health service policy, is to be conducted confidentially. Overall, results highlighted partner involvement in perinatal depression screening and psychosocial assessment processes and identified some of the benefits such as partner disclosure, but also the challenges and complexities of inclusion of partners. Clinical implications and directions for further education and research are discussed.

[Perceived needs of women regarding maternity. Qualitative study to redesign maternal education]. / Necesidades percibidas por las mujeres respecto a su maternidad. Estudio cualitativo para el rediseño de la educación maternal.

OBJECTIVES: To assess women's perceptions of their needs during the process of becoming a mother and identify what they want from maternal education. DESIGN: Qualitative study with focus groups. SETTING: Bizkaia health region, Basque Health Service (Osakidetza), Spain. PARTICIPANTS: Thirty one women were recruited consecutively by midwives at six Osakidetza health centres. METHODS: Four sessions were held from September to November 2010 in Bizkaia (Spain), the four groups being stratified by socioeconomic status and stage of the process (pregnancy vs. postnatal period). To collate the information related to the various topics discussed, we used manifest content analysis that was facilitated by use of ATLAS.ti software. RESULTS: The focus of the women worries changes over time. In early pregnancy, women's main concern was for "everything to go well". As the pregnancy progressed, they needed more emotional support and wanted to feel confident and be self-reliant to face their fears of the birth and care for their child. They needed greater accompaniment in the puerperium and less pressure concerning breastfeeding. They also wanted an extended programme of perinatal rather than just antenatal education, which was more participatory and flexible and greater participation of their partner. CONCLUSION: Women have the same social and family networks needs, regardless of cultural differences between Anglo-Saxon and Southern European countries. We recommend an perinatal education to empower women to manage their own health and that of their family and link the health system with other networks of personal and social support for women.

Association between maternal dental periapical infections and pregnancy outcomes: results from a cross-sectional study in Malawi.

OBJECTIVES: Maternal infections are associated with intrauterine growth restriction (IUGR) and preterm birth (PTB). Dental infections are common in low-income settings, but their contribution to adverse pregnancy outcomes is unknown. We studied the epidemiology of dental periapical infections among pregnant women and their association to foetal growth restriction and the duration of pregnancy in a rural sub-Saharan African population. METHODS: This was a cross-sectional study on the association between maternal dental periapical infections and birth outcomes, in Malawi, Africa. We assessed oral health clinically and radiologically among recently delivered women with known duration of pregnancy and measured birthweight (BW), length and head circumference of their infants. RESULTS: Of 1024 analysed participants, 23.5% had periapical infections. Mean duration of pregnancy was 39.4 weeks, BW 2979 g and length 49.7 cm. Women with periapical infection had mean (95% CI) pregnancy duration 0.4 weeks (0.1-0.8) shorter and delivered infants with 79 g (13-145) lower BW and 0.5 cm (0.2-0.9) shorter neonatal length than women without periapical infection. The incidence of PTB was 10.0% among women with periapical infection and 7.3% among those without (adjusted difference 3.5%, 95% CI -1.1-8.1%). Corresponding prevalences for stunting were 20.9% and 14.2% (adjusted difference 9.0%, 95% CI 2.7%-15.2%). The population-attributable risk fraction attributable to periapical infection was 9.7% for PTB and 12.8% for stunting. CONCLUSIONS: Periapical infection was associated with shorter pregnancy duration and IUGR in the study area; interventions addressing this risk factor may improve birth outcomes in low-income settings.

The Spanish Society of Neurology's official clinical practice guidelines for epilepsy. Special considerations in epilepsy: comorbidities, women of childbearing age, and elderly patients.

INTRODUCTION: The characteristics of some population groups (patients with comorbidities, women of childbearing age, the elderly) may limit epilepsy management. Antiepileptic treatment in these patients may require adjustments. DEVELOPMENT: We searched articles in Pubmed, clinical practice guidelines for epilepsy, and recommendations by the most relevant medical societies regarding epilepsy in special situations (patients with comorbidities, women of childbearing age, the elderly). Evidence and recommendations are classified according to the prognostic criteria of Oxford Centre of Evidence-Based Medicine (2001) and the European Federation of Neurological Societies (2004) for therapeutic interventions. CONCLUSIONS: Epilepsy treatment in special cases of comorbidities must be selected properly to improve efficacy with the fewest side effects. Adjusting antiepileptic medication and/or hormone therapy is necessary for proper seizure management in catamenial epilepsy. Exposure to antiepileptic drugs (AED) during pregnancy increases the risk of birth defects and may affect fetal growth and/or cognitive development. Postpartum breastfeeding is recommended, with monitoring for adverse effects if sedative AEDs are used. Finally, the elderly are prone to epilepsy, and diagnostic and treatment characteristics in this group differ from those of other age groups. Although therapeutic limitations may be more frequent in older patients due to comorbidities, they usually respond better to lower doses of AEDs than do other age groups.

[Expectations and user experiences of older Roma women with health services in primary care]. / Expectativas y experiencias de uso de las mujeres gitanas mayores ante los servicios sanitarios de atención primaria.

OBJECTIVE: To know the expectations and user experiences of older Roma women with health services in primary care (PC). DESIGN: Phenomenological qualitative study. Using focus groups (4-9 women/group) and semistructured interviews. Audio recorded from March to November 2011. LOCATION: Performed in Úbeda and Linares (Spain). PARTICIPANTS AND SETTING: Roma women over 50years. A purposive sample stratified by age and area of residence was carried out. Woman were recruited through community leaders. METHOD: Process of qualitative content analysis: coding, triangulation, obtain and verify results. Supported whit the software Nvivo 8. RESULTS: Three focus groups and four interviews were conducted, including 23 women. The expectations for the PC are focus exclusively on their physician, being invisible other professionals. They look for a relationship with their physician based on trust. In their user experience with the PC coexist three types of user: who goes to their appointments, demands attention only in acute disease and does not attend appointments and reviews. There are socio-cultural factors related to accessibility. CONCLUSIONS: Older Roma women set their expectations and experiences with health service in PC around the binomial disease/physician. Expect attention based on trust and a high instrumentalization. A speech with signs of change directed towards a more active and demanding participation in PC services is observed.

Executive summary of the consensus statement on assistance to women with HIV infection in the health care sector. National AIDS Plan (PNS) and AIDS Study Group (GeSIDA).

The aim of this paper was to develop a consensus on clinical recommendations for health care assistance for women with HIV infection. To this end, a panel of experts, appointed by the Secretariat of the National AIDS Plan and GeSIDA was assembled, that included internal medicine physicians with expertise in the field of HIV infection, gynecologists, pediatricians and psychologists, with two members of the panel acting as coordinators. Scientific information was reviewed in publications and conference reports up to October 2012. In keeping with the criteria of the Infectious Disease Society of America, two levels of evidence were applied to support the proposed recommendations: the strength of the recommendation according to expert opinion (A, B, C) and the level of empirical evidence (I, II, III), already used in previous documents from SPNS/GESIDA. Multiple recommendations are provided for the clinical management of women with HIV infection, considering both the diagnostic and possible therapeutic strategies. This document presents recommendations for the treatment of women with HIV infection. This must be multidisciplinary, taking into account the differences that can be found in the diagnosis, development of disease and treatment between men and women.

[Consensus statement on monitoring of HIV: pregnancy, birth, and prevention of mother-to-child transmission]. / Documento de consenso para el seguimiento de la infección por el virus de la inmunodeficiencia humana en relación con la reproducción, el embarazo, el parto y la profilaxis de la transmisión vertical del niño expuesto.

OBJECTIVE: The main objective in the management of HIV-infected pregnant women is prevention of mother-to-child transmission; therefore, it is essential to provide universal antiretroviral treatment, regardless of CD4 count. All pregnant women must receive adequate information and undergo HIV serology testing at the first visit. METHODS: We assembled a panel of experts appointed by the Secretariat of the National AIDS Plan (SPNS) and the other participating Scientific Societies, which included internal medicine physicians with expertise in the field of HIV infection, gynecologists, pediatricians and psychologists. Four panel members acted as coordinators. Scientific information was reviewed in publications and conference reports up to November 2012. In keeping with the criteria of the Infectious Diseases Society of America, 2levels of evidence were applied to support the proposed recommendations: the strength of the recommendation according to expert opinion (A, B, C), and the level of empirical evidence (I, II, III). This approach has already been used in previous documents from SPNS. RESULTS AND CONCLUSIONS: The aim of this paper was to review current scientific knowledge, and, accordingly, develop a set of recommendations regarding antiretroviral therapy (ART), regarding the health of the mother, and from the perspective of minimizing mother-to-child transmission (MTCT), also taking into account the rest of the health care of pregnant women with HIV infection. We also discuss and evaluate other strategies to reduce the MTCT (elective Cesarean, child's treatment…), and different aspects of the topic (ARV regimens, their toxicity, monitoring during pregnancy and postpartum, etc.).

[Consensus statement on assistance to women with human immunodeficiency virus infection in the health care sector. National AIDS Plan (PNS) and AIDS Study Group (GeSIDA)]. / Documento de consenso sobre la asistencia en el ámbito sanitario a las mujeres con infección por el virus de la inmunodeficiencia humana.

OBJECTIVE: To develop a consensus document on clinical recommendations for the health care of women with human immunodeficiency virus (HIV) infection. METHODS: We assembled a panel of experts appointed by the Secretariat of the National AIDS Plan and GeSIDA that included internal medicine physicians with expertise in the field of HIV infection, gynecologists, pediatricians and psychologists, and two panel members acting as coordinators. Scientific information was reviewed in publications and conference reports up to October 2012. In keeping with the criteria of the Infectious Disease Society of America, two levels of evidence were applied to support the proposed recommendations: the strength of the recommendation according to expert opinion (A, B, C), and the level of empirical evidence (i, ii, iii), already used in previous documents from SPNS/GeSIDA. RESULTS: We provide multiple recommendations for the clinical management of women with HIV infection, considering both the diagnostic and possible therapeutic strategies. The consensus recommends gender mainstreaming in health care, and promoting training for healthcare professionals in order to avoid gender bias. With currently available data it seems that the effectiveness of the treatment is the same in both men and women, there being no limitation as to the use of any antiretroviral for this reason. Women have more treatments suspended for reasons other than virological failure, thus they require better monitoring. CONCLUSIONS: This document presents recommendations for addressing women with HIV infection. This must be multidisciplinary, taking into account the differences that can be found in the diagnosis, disease development, and treatment between men and women.

[Domestic violence: a current issue to take into account in diagnostic imaging]. / El radiodiagnóstico ante la violencia de género: un tema de actualidad a tener en cuenta.

Domestic violence is currently an issue of great political and social importance. The real incidence of domestic violence is difficult to determine due to the environment where it takes place and the reluctance of victims to report abuse. On the other hand, all types of violence represent an important public health problem. We report the case of a young woman who presented with thromboembolic phenomena at different sites due to domestic violence. We emphasize that it is necessary for radiologists and other healthcare professionals to consider the possibility of domestic violence when establishing the diagnosis. This can be important for determining the incidence of abuse, diminishing its sequela, and help increase its reporting.