Gender differences, inequalities and biases in the management of Acute Coronary Syndrome.

OBJECTIVE: The approach to Acute Coronary Syndrome from a gender perspective is relatively recent. Research is extensive at epidemiological and clinical levels. However, available evidence, besides neglecting the social dimensions of the disease, has made women invisible. The objective of this review was to analyze the inequalities and gender biases in Acute Coronary Syndrome, from the beginning of the disease process to the final resolution. METHODS: An exhaustive review of the literature of the entire health care process, from risk factors to rehabilitation and recovery, was carried out. The search for articles on gender, gender inequalities, or gender bias was conducted in indexed journals of social and health sciences. Also, a specific search was performed for each stage of the process, such as risk factors, prehospital phase, diagnosis, treatment, and rehabilitation. RESULTS: Results showed the presence of gender biases throughout the entire health care process in Acute Coronary Syndrome. It is shown gender inequalities in the access to medical care, including a poor recognition among women themselves as well as among health professionals; longer prehospital delays; inadequate diagnoses and treatments; or less assistance to cardiac rehabilitation programmes. These biases occurred at the different levels of the health services involved. Finally, this review included recommendations proposed or arising from the revised papers. CONCLUSIONS: Reducing gender biases in Acute Coronary Syndrome implies developing strategies to raise awareness among women, improve training of professionals serving at the different levels of health services, reduce delays, develop health management measures, and promote a research agenda.

Factors associated with workability in Spanish health centre workers.

BACKGROUND: The concept of workability provides a conceptual framework and proposes measures for the evaluation of relevant actions focused on a healthy workforce. In Spain, one of the countries with the highest life expectancy, there are practically no scientific studies on workability and its associated factors. AIMS: The objective of this study is to examine the associations between workability and variables related to health and work in a sample of workers from Spanish health centres. METHODS: Cross-sectional study including 1184 health centre workers who completed a questionnaire at baseline, comprising measures of workability, health and other work-related factors. Workability has been analysed as a one-factor construct, and as a two-factor construct. Multinomial logistic regression models were used to analyse factors associated with workability. RESULTS: As a one-dimensional construct, workability is associated with physical and mental health, number of hours of worked, insomnia, work and family life balance, adequate training, never having had an accident and type of contract. When the two-factor measure was used, sensitivity of findings increased, and it was identified that those participants who were older, lived alone and have more years of service in their profession also show worse workability. CONCLUSIONS: The present study identified factors associated with the workability of health centre workers. The two-factor workability index (WAI) has better psychometric properties and used in combination with the global measure of WAI, identifies important additional aspects, specifically, age and years of professional experience as additional considerations for the intervention.

[Factors associated with prehospital delay in men and women with acute coronary syndrome]. / Factores asociados a la demora prehospitalaria en hombresy mujeres con síndrome coronario agudo.

OBJECTIVE: To identify factors associated with prehospital delay in people who have had an acute coronary syndrome. METHODS: Using a survey we studied patients admitted due to acute coronary syndrome in the 33 Andalusian public hospitals, obtaining information about different types of variables: socio-demographic, contextual,clinical, perception, action, and transportation.Multivariate logistic regression models were applied to calculate the odds ratios for the delay. RESULTS: Of the 1,416 patients studied, more than half had a delay of more than an hour. This is associated to distance to the hospital and means of transport: when the event occurs in the same city,using the patient's own means of transport increases the delay, odds ratio = 1.51 (1.02 to 2.23); if the distance is 1 to 25 kilometers from the hospital,there is no difference between the patient's own means of transport and an ambulance, odds ratio =1.41 and odds ratio =1.43 respectively; and when the distance exceeds 25 kilometers transport by ambulance means more delay, odds ratio = 3.13 and odds ratio = 2.20 respectively. Also, typical symptoms reduce delay amongst men but increase amongst women. Also, not caring and waiting for the resolution of symptoms, seeking health care other than a hospital or emergency services, previous clinical history, being away from home, and having an income under 1,500 euros, all increase delay. Respiratory symptoms reduce delay. CONCLUSIONS: Prehospital delay times do not meet health recommendations. The physical and social environment,in addition to clinical, perceptual and attitudinal factors, are associated with this delay.

Factores asociados a la demora prehospitalaria en hombres y mujeres con síndrome coronario agudo / Factors associated with prehospital delay in men and women with acute coronary syndrome

Fundamento: Identificar factores asociados a la demora prehospitalaria en personas que han tenido un síndrome coronario agudo Material y métodos: Se estudiaron mediante encuesta pacientes ingresados por síndrome coronario agudo en los 33 hospitales públicos andaluces, obteniéndose información sobre diferentes tipos de variables: socio-demográficas, contextuales, clínicas, percepción, actuaciones, y transporte. Se aplicaron modelos de regresión logística multivariante para calcular las odds ratio para la demora. Resultados: De los 1.416 pacientes en total, más de la mitad tuvieron una demora superior a la hora. Se asocia a la distancia al hospital y al medio de transporte: cuando el evento ocurre en la misma ciudad del hospital, utilizar medios propios aumenta la demora, odds ratio= 1,51 (1,02-2,23); si la distancia es entre 1-25 kilómetros, no hay una diferencia entre medios propios y ambulancia, odds ratio = 1,41 y odds ratio = 1,43 respectivamente; y cuando supera los 25 kilómetros la ambulancia implica mayor demora, odds ratio = 3,13 y odds ratio = 2,20 respectivamente. Además, la sintomatología típica reduce la demora entre los hombres, pero la aumenta entre las mujeres. Asimismo, no darle importancia, esperar a la resolución de los síntomas, buscar atención sanitaria diferente a urgencias hospitalarias o al 061, tener antecedentes, encontrarse fuera de la vivienda habitual, y tener ingresos menores de 1.500 euros aumentan la demora. Tener síntomas respiratorios la reduce. Conclusiones: La demora prehospitalaria no se ajusta a las recomendaciones sanitarias, asociándose al entorno físico y social, a factores clínicos, y de percepción y actitudinales de los sujetos (AU)

Objective. To identify factors associated with prehospital delay in people who have had an acute coronary syndrome. Methods. Using a survey we studied patients admitted due to acute coronary syndrome in the 33 Andalusian public hospitals, obtaining information about different types of variables: socio-demographic, contextual, clinical, perception, action, and transportation. Multivariate logistic regression models were applied to calculate the odds ratios for the delay. Results. Of the 1,416 patients studied, more than half had a delay of more than an hour. This is associated to distance to the hospital and means of transport: when the event occurs in the same city, using the patient’s own means of transport increases the delay, odds ratio = 1.51 (1.02 to 2.23); if the distance is 1 to 25 kilometers from the hospital, there is no difference between the patient’s own means of transport and an ambulance, odds ratio = 1.41 and odds ratio =1.43 respectively; and when the distance exceeds 25 kilometers transport by ambulance means more delay, odds ratio = 3.13 and odds ratio = 2.20 respectively. Also, typical symptoms reduce delay amongst men but increase amongst women. Also, not caring and waiting for the resolution of symptoms, seeking health care other than a hospital or emergency services, previous clinical history, being away from home, and having an income under 1,500 euros, all increase delay. Respiratory symptoms reduce delay. Conclusions. Prehospital delay times do not meet health recommendations. The physical and social environment, in addition to clinical, perceptual and attitudinal factors, are associated with this delay (AU)

Actuación de los pacientes ante un síndrome coronario agudo: diferencias desde una perspectiva de género / Patient responses to symptoms of acute coronary syndrome: a gender-perspective study

Objetivos: Conocer las características del entorno, pensamientos, actuaciones y tipo de transporte utilizado en hombres y mujeres con síndrome coronario agudo –SCA– (infarto agudo de miocardio y angina inestable) al inicio de los síntomas. Método: Estudio observacional descriptivo de una muestra representativa de pacientes ingresados en las unidades de cuidados intensivos de 33 hospitales públicos de las 8provincias andaluzas, entre 2007 y 2010, con diagnóstico al alta de SCA. Resultados: Se obtuvieron 1.416 encuestas: 948 hombres y 468 mujeres, con una edad media de 63,0 años y 70,5, respectivamente. Los síntomas se inician mayormente en la vivienda habitual y por la mañana. Menos de una tercera parte de las personas encuestadas supo desde el principio que se trataba de un infarto (hombres 29,9%, mujeres 24,2% p < 0,001). El 26,0% lo primero que hace es telefonear o desplazarse en busca de familiares, amistades o gente vecina, además las personas realizan más de (..) (AU)

Objective: To determine the environmental characteristics and the opinions, behaviors, and types of transfer to hospital of men and women who experience symptoms of acute coronary syndrome (acute myocardial infarct and unstable angina).Methods: Descriptive observational study of a representative sample of patients with a diagnosis of acute coronary syndrome who were admitted to the intensive care units of 33 public health service hospitals in 8 provinces in Andalusia, Spain, between 2007 and 2010.Results: A total of 1416 surveys were completed; 948 were for men and 468 were for women (mean [SD] ages, 63.0and 70.5 years, respectively). Symptoms usually began in the patient’s home. Fewer than a third of the patients surveyed knew they were experiencing a coronary event from the beginning of symptoms (29.9% of men and 24.2% of women;P<.001). The first reaction of 26.0% was to call or try to find a family member, friend, or neighbor. Many (..) (AU)

[Family caregivers of people with neurodegenerative disease: profile, contributions, and impact of care]. / Cuidadores familiares de personas con enfermedad neurodegenerativa: perfil, aportaciones e impacto de cuidar.

OBJECTIVE: To analyse the informal system of caring for people with neuro-degenerative disease: what it consists of and the characteristics of main carers, the type of care given, and the consequences for the main carer of assuming these functions. DESIGN: Descriptive cross-sectional study conducted by means of a home-filled questionnaire. SETTING: Autonomous Community of Andalusia. PARTICIPANTS: 72 main carers of someone with neuro-degenerative disease, chosen from a sub-sample of 1000 homes in which at least one dependent person lives and receives care from a member of his/her family or social network with whom he/she resides. This sub-sample was based on a random sample of 3160 Andalusian homes stratified proportionately according to province and size of dwelling. MAIN RESULTS: In 86.1% of the 72 homes polled, health care was provided only by the informal system network. In over half the homes, care was provided by just one person, the main carer. The main carer was usually a woman (87.4%), with an average age of 54.52, house-wife and close family member of the sick person. In our study the beneficiaries of care had an average age of 77.63, a low level of autonomy in daily activities, and had had a neuro-degenerative disease for an average of 8.16 years. The main kinds of care provided in the home for people with neuro-degenerative disease were help in instrumental activities, care related to daily activities, observation/company and supervision of medicines. Main carers believed that undertaking this work had seriously affected their health (72.2%), the use they made of their time (84.7%), their social life (83.3%) and their economic position (44.4%). CONCLUSIONS: People with neuro-degenerative disease make considerable demands on health care provision, which is mainly covered at home by the immediate family network. In most cases this network consists of just one person, the main carer, on whom falls the entire burden of care. The assumption of this role directly affects the health of a large number of carers, as well as other areas of their lives, in particular the possibility of conducting a social life and using their time for themselves or for activities other than caring.

Cuidadores familiares de personas con enfermedad neurodegenerativa: perfil, aportaciones e impacto de cuidar / Family carers of people with neuro-degenerative illness: profile, contributions and impact of care

Objetivo. Analizar el sistema informal de cuidados de personas con enfermedad neurodegenerativa, en cuanto a su composición y a las características de los cuidadores principales, el tipo de cuidados que presta y las consecuencias que tiene para el cuidador principal asumir estas funciones. Diseño. Estudio descriptivo de corte transversal realizado mediante cuestionario domiciliario. Emplazamiento. Comunidad Autónoma de Andalucía. Participantes. Setenta y dos cuidadores principales de alguna persona con enfermedad neurodegenerativa, seleccionados de una submuestra de 1.000 hogares en los que vive al menos una persona dependiente por alguna razón y que recibe cuidados de algún miembro de su red familiar o social con el que reside. Esta submuestra se obtuvo a partir de una muestra aleatoria de 3.160 hogares andaluces, estratificada proporcionalmente según provincia y tamaño de hábitat. Resultados principales. En un 86,1 por ciento de los 72 hogares encuestados, los cuidados de salud son prestados sólo por la red el sistema informal. En más de la mitad de los hogares los cuidados son realizados por una sola persona, el cuidador principal. Éste suele ser una mujer (87,4 por ciento), con una edad media de 54,52 años, ama de casa y familiar cercano de la persona afectada. Los beneficiarios de nuestro estudio tienen una edad media de 77,63 años, un nivel bajo de autonomía para actividades de la vida diaria y enfermedad neurodegenerativa desde hace una media de 8,16 años. Los principales cuidados que se prestan en el hogar a personas con enfermedad neurodegenerativa son ayuda en actividades instrumentales, cuidados relacionados con actividades de la vida diaria, vigilancia/acompañamiento y administración de la toma de medicamentos. Las cuidadoras principales consideran que desempeñar este trabajo ha afectado de forma importante a su salud (72,2 por ciento), al uso que hacen de su tiempo (84,7 por ciento), a su vida social (83,3 por ciento) y a su situación económica (44,4 por ciento). Conclusiones. Las personas con enfermedad neurodegenerativa presentan una importante demanda de cuidados de atención a la salud, que en gran parte es cubierta en el hogar por su red familiar inmediata. En la mayoría de los casos esta red se halla configurada por una sola persona, la cuidadora principal, sobre la que recae toda la carga de los cuidados. Para un importante grupo de cuidadoras, asumir este rol afecta de forma directa a su salud, así como a otras áreas de su vida y, en especial, a sus posibilidades de tener relaciones sociales y de usar el tiempo para sí mismas o para otras actividades diferentes a cuidar (AU)

El grupo focal como técnica de investigación cualitativa en salud: diseño y puesta en práctica / The focus group as a technique of quality health research: design and putting into practice

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High-frequency components of normal and dysphonic voices.

The analysis of high-frequency energy levels can presently be considered as being more influenced by the characteristics of the speaker than by the phonetic material, serving as an indicator of the quality of the voice. In this study the energy levels in the frequency intervals of 6-10 and 10-16 kHz were evaluated, both in dysphonic voices and in subjects with no voice problems. The material consisted of consonant-vowel syllables formed by stop phonemes and the basic Spanish vowels, analyzing the vocal segment. The results indicate that the energy, found from the power spectrum average, in both frequency areas, is significantly bigger in the group with dysphonic voices. The analysis in the 10-16 kHz regions shows additional significant differences of energy between the vowels, progressively decreasing from front to back vowels.