Gender-transformative school-based sexual health intervention: study protocol for a randomized controlled trial.

BACKGROUND: There is general agreement that sexuality is a central aspect of human development; it is key in sexual health and reproductive education during adolescence. However, in spite of the existing interventions on this topic and the evidence generated, the inclusion of a gender focus in sexuality is relatively recent and there is little evidence available, thus structured and corroborated interventions with a gender-transforming perspective in sexuality are required. METHODS: We will use a mixed method experimental design with a parallel cluster-randomized trial (GRTs) that will evaluate the effectiveness of a comprehensive gender-transformative intervention of sexual education (ENFOCATE -Focus-on-), which will be complemented with qualitative studies to understand the implementation process. The participants will be 609 10th and 11th-grade students. The randomization will be by grade, and the data will be collected at three moments (pre-intervention, post-intervention, and a 3-month follow-up). DISCUSSION: Comprehensive, gender-focused, and culturally pertinent interventions in sexuality are needed for adolescents of countries with high, middle, and low incomes. These produce better results in terms of sexual health, and including a gender-transformative focus contributes to equity in health. Focus-on is unique since it uses a comprehensive gender-transformative intervention in sexual education that will allow putting into practice a program based both on international evidence and that which arises from the object population. It also uses a culturally-sensitive focus, since it is designed based on the characteristics of the object population; it will allow adapting some activities to the needs of the context in which it is developed. TRIAL REGISTRATION: The study was prospectively registered on June 6, 2023, at ClinicalTrials.gov ID: NCT05896540. Protocol version number 1.0. May 22, 2023.

The inclusion of the gender perspective in oncology research with Spanish participation.

The gender perspective is important for a better diagnosis and treatment of diseases, especially in the field of oncology. This study aimed to analyse the gender approach in scientific articles in the field of oncology by studying the gender composition of the authorship of papers and the gender inclusion in the research carried out. A bibliographic search of articles and reviews signed by at least one Spanish institution published between 2010 and 2019 was carried out using the Science Citation Index Expanded database in the Oncology category. A total of 7523 studies were classified according to the gender composition determined by the author's name and a randomised sample was used to evaluate the inclusion of gender perspectives using a checklist. This study revealed a lack of gender parity in the authorship of oncology publications involving Spanish participation. Papers without author gender parity were eight times higher than papers with parity and showed a greater presence of male than female authorship (58 % versus 31 %). Regarding the introduction of the gender perspective, a negative response of 68 % referring to compliance with the entire checklist was obtained, and only a fifth of the articles presented gender balance in the study sample. Moreover, there is a positive correlation between gender parity in authorship and gender perspective integration in published research. In conclusion, there is a great need to advance the inclusion of gender perspectives in cancer research to overcome gender bias and promote better prevention, detection, and intervention for cancer.

The role of women in the field of early intervention.

This study examines the intersection of early intervention and the role of women as primary caregivers for children with disabilities. Studies for this analysis were collected through a meticulous search in the Web of Science (WoS) and Scopus databases. This process ensured the inclusion of a wide range of relevant literature from the field of study. A rigorous procedure of identification, selection, eligibility assessment, and inclusion of potentially relevant studies in this research area was conducted. We analyzed 130 articles, identifying 8 key research areas. Significant factors include the impact on parental interactions, communication skills, the role of women in developmental disabilities, mothers' understanding of their children's disabilities, emotional overload, parental stress, and psychological aspects. These factors significantly affect the well-being and development of mothers and children with disabilities. The study also considers the impact on women's careers. While research on psychological aspects and maternal overload is well-developed, establishing early intervention systems to optimize resources for proper child development is a challenge. The findings have high social value, paving the way for improving the quality of early childhood services.

Gender differences in symptomatology, socio-demographic information and quality of life in Spanish population with long COVID condition: a cross-sectional study.

Introduction: Long COVID patients experience a decrease in their quality of life due to the symptomatology produced by the disease. It is also important to understand how long COVID affects both men and women. The objective of this study is to examine the impact of long COVID symptomatology on the quality of life of Spanish adults from a gender perspective. Methods: An observational and cross-sectional study was carried out. Participants were able to complete an online questionnaire using an online platform. A sample of 206 people participated in the study. Results: The 80.6% of the sample were women with a mean age of 46.51 (±8.28) and the 19.4% were men with a mean age of 48.03 (±9.50). The medium score in the PAC19-QoL test was 141.47 (±24.96) and segmented by gender, 141.65 (±23.95) for women and 140.82 (±28.66) for men. The most common symptoms in women were muscle and joint pain (94.6%), fatigue (94.0%), discomfort (92.2%), difficulty concentrating (91.0%), and memory loss (88.6%). For men the symptoms included muscle and joint pain (97.5%) and fatigue (97.5%) both occupying first position, discomfort (92.0%), difficulty concentrating (90.0%), mood disturbances (90.0%), and memory loss (87.5%). The chi-square test showed statistical significance (p < 0.005) for socio-demographic information, quality of life scores, and long COVID symptoms by intensities. Conclusion: This study shows that there are gender differences in the way that long COVID is experienced.

Ideación suicida entre reclusos: análisis con perspectiva de género, durante cinco años de seguimiento (2017-2022) / Suicidal ideation among prisoners: analysis with a gender perspective in a five-year follow-up (2017-2022)

Introducción: En el entorno penitenciario, hay una elevada incidencia de conductas autolesivas, con una tasa de suicidio superior a la existente en la población general. Estudios previos describen la asociación de factores sociodemográficos, clínicos y criminológicos, con el riesgo de suicidio en la población penitenciaria masculina, pero hay pocas investigaciones centradas en el análisis de la conducta suicida entre mujeres. El objetivo del trabajo es analizar las características de las internas que ingresan en una unidad psiquiátrica por presentar ideas de suicidio o haber realizado tentativas.Material y método: Análisis descriptivo y comparativo de 97 internos (68 hombres, 29 mujeres) ingresados en la Unidad de Hospitalización Psiquiátrica de la Penitenciaria de Cataluña (UHPP-C), por ideas de suicidio, entre el 1 de enero de 2017 y el 31 de diciembre de 2022. Resultados: Se encuentran diferencias respecto al lugar de nacimiento, con mayor presencia de nacionalidades africanas en varones no nacionales, mientras que las internas extranjeras suelen ser originarias de países latinoamericanos. Los hombres tienen menor edad media, con ingresos más prolongados y una mayor tasa de reingreso. También padecen más trastornos psicóticos y adictivos. Las mujeres presentan mayor prevalencia de trastornos de personalidad y cuadros afectivos. Conclusiones: Hay diferencias sociodemográficas y clínicas entre hombres y mujeres internos en prisión que requieren ingreso por ideación suicida. Incluir la perspectiva de género en los estudios sobre el riesgo suicida en la población penitenciaria puede proporcionar una base sólida para futuros estudios, permitiendo así una comprensión más completa de la ideación suicida y las necesidades de intervención en la población penitenciaria.(AU)

Introduction: There is a high incidence of self-harming behavior in the prison setting, with a suicide rate that is higher than that of the general population. Previous studies describe the association of sociodemographic, clinical, and criminological factors with the risk of suicide in the male prison population, but there is little research that specifically analyses suicidal behavior among women. The objective of this study is to analyze the characteristics of inmates who are admitted to a psychiatric unit for suicidal thoughts or attempted suicide. Material and method: Descriptive and comparative analysis of 97 inmates (68 men, 29 women) admitted to the Unidad de Hospitalización Psiquiátrica Penitenciaria de Cataluña (UHPP-C), for suicidal ideation, between January 1, 2017, and December 31, 2022. Results: There are differences in terms of place of birth, with a more significant presence of African nationalities in non-national males, while foreign inmates tend to come from Latin American countries. Men have a lower mean age, longer admissions, and a higher readmission rate. They also suffer from more psychotic and addictive disorders. Women have a higher prevalence of personality disorders and affective symptoms. Conclusions: There are sociodemographic and clinical differences between male and female prison inmates who require admission for suicidal ideation. Including a gender perspective in studies on suicide risk in the prison population can provide a solid foundation for future studies, thus allowing a more complete understanding of suicidal ideation and intervention needs in theprison population.(AU)

Gender perspective in the implementation of hygiene in cardiology intensive care.

INTRODUCTION: Hygiene in critical patients is an essential daily care, provided under safe conditions, to promote comfort and maintain the integrity of skin and mucous membranes, however, it can generate feelings of dependence and vulnerability in patients. The aim of this post hoc study is to know the differences in satisfaction and lived experience regarding bed hygiene in an intensive care unit according to biological sex and gender perspective. METHODS: Observational, descriptive and prospective study in which an ad hoc questionnaire was administered to 148 conscious and oriented patients of legal age. The questionnaire was completed 24-48 hours after admission to the unit, once the initial bed hygiene had been performed. RESULTS: Males experienced conformism (51%), embarrassment (31%) and relief (9%); Women felt conformism (35.4%), embarrassment (18.8%) and relief (29.2%) (p < 0.05). Women experienced a feeling of cleanliness in 89.1% compared to 56.1% of men (p < 0.05). Men were offered to wash their genitals in 72.9% compared to 35.7% of women (p < 0.05). 34.3% of men would prefer a family member to assist them during hygiene (62.9% by their wives), compared to 27.1% of women who would prefer a family member (84.6% by their daughters). CONCLUSION: Women tolerate bed hygiene better than men and appreciate more the feeling of cleanliness. Women are identified as caregivers, both professionally and in the family, and patients prefer them to collaborate in the performance of hygiene, being wives preferred by men and daughters preferred by women.

[Women drug-users in outpatient treatment: a qualitative study from a gender and community mental health perspective]. / Mujeres consumidoras de drogas en tratamiento ambulatorio: estudio cualitativo desde una perspectiva de género y de salud mental comunitaria.

Women drug-users face significant challenges in accessing and adhering to outpatient treatment. However, this issue has been underexplored. The study aims to understand the experiences of a group of women undergoing drug use treatment. Between March and December 2021, a qualitative phenomenological interpretative study was carried out through semi-structured interviews with 16 women attending a drug-dependence care center in Catalonia, Spain. Data were processed through content analysis. The results indicate that, despite perceiving a positive impact of the treatment, women experience vulnerabilities related to stigmatization, lack of social support, and insufficient coverage of specific needs, impacting therapeutic follow-up. The findings emphasize the need to enhance resources for specialized care and promote a social support network where women drug-users actively participate.

Las mujeres consumidoras de drogas se enfrentan a grandes desafíos en el acceso y la adherencia al tratamiento ambulatorio. Sin embargo, esta cuestión ha sido poco estudiada. El objetivo del estudio es comprender las experiencias de un grupo de mujeres en tratamiento por consumo de drogas. Entre marzo y diciembre de 2021, se realizó un estudio cualitativo fenomenológico interpretativo mediante entrevistas semiestructuradas a 16 mujeres usuarias de un centro de atención a las drogodependencias de Cataluña (España). Los datos se procesaron mediante el análisis de contenido. Los resultados indican que las mujeres, pese a percibir un impacto positivo del tratamiento, viven realidades de vulnerabilidad relacionadas con la estigmatización, la falta de apoyo social y una baja cobertura de necesidades específicas con implicaciones en el seguimiento terapéutico. Los hallazgos enfatizan la necesidad de mejorar los recursos para una atención especializada y promover una red de apoyo social donde participen activamente las mujeres consumidoras de drogas.

Implicancias teórico-clínicas de las prácticas psicoterapéuticas feministas o con perspectiva de género en Chile / Theoretical-clinical implications of feminist or gender-sensitive psychotherapeutic practices in Chile

Este artículo tiene como objetivo comprender, mediante el análisis de 16 entrevistas semies-tructuradas, las implicancias teórico-clínicas del posicionamiento con perspectiva de género o feminista en la práctica psicoterapéutica contemporánea en Chile, desde la perspectiva de consultantes y psicoterapeutas. Como resultados, se observa que el valor de esta psicoterapia radica en entregar una lectura sociocultural del malestar generizado. Sin embargo, quienes consultan reproducen estereotipos de género al elegir este enfoque a propósito del género fe-menino de la psicoterapeuta, pues consideran que habría un mayor entendimiento “por ser mu-jer”, lo cual les garantizaría un espacio seguro, libre de juicios y revictimización. Se destaca que las intervenciones de este enfoque tienen un componente político que favorece el trabajo de la desculpabilización de las consultantes. Esto resulta favorable en ciertos casos, pero po-dría obstaculizar el abordaje y reconocimiento de aquellas características singulares del sujeto que inciden en el sufrimiento y trascienden la certeza ideológica. (AU)

This article aims to understand, through 16 semi-structured interviews analysis, the theoreti-cal-clinical implications of the gender or feminist perspective in contemporary psychothera-peutic practice in Chile, from the perspective of consultants and psychotherapists. As a result, it is observed that the value of this psychotherapy lies in providing a sociocultural reading of gendered discomfort. However, those who consult reproduce gender stereotypes by choosing this approach due to the female gender of the psychotherapist, as they consider that there would be a better understanding “because of her being a woman”, which would guarantee them a safe space, free of judgments and revictimization. It should be noted that the inter-ventions of this approach have a political component that favors the work of disempowerment of the consultants. This is favorable in certain cases but could hinder the approach and recog-nition of those unique characteristics that affect particularsuffering in every case and trans-cend ideological certainty. (AU)

Tesis doctorales españolas de ciencias de la salud en materia de género (1976-2022) / Spanish doctoral thesis in health sci-ences on gender subjects (1976-2022)

Objetivo principal: analizar cuantitativamente la producción de las tesis doctorales en materia sanitaria relacionadas con el género en España. Metodología: síntesis cuantitativa de indicadores de productividad de las tesis doctorales conseguidas en la base de datos española TESEO y defendidas en Universidades españolas entre 1976 y 2022. Los análisis empleados han sido descriptivos y el cálculo de predicción se basó en la metodología del modelo Holt-Winters. Resultados principales: el 18,75% de las tesis defendidas pertenecen a una Universidad de Madrid. El 75% de ellas son defendidas por graduados en Medicina. La temática de las tesis es en el 25% la violencia de género. El 87,5% son doctoras, pero solamente el 44% de las mujeres dirigen tesis. La predicción para los futuros 24 años indica que se generará alrededor de 1 tesis al año. Conclusión principal: la investigación española en tesis doctorales clínicas de género es escasa y masculinizada.(AU)

Main objective: to quantitatively analyze the production of gender-related doctoral theses in health in Spain. Methodology: quantitative synthesis of productivity indicators of the doctoral theses obtained in the Spanish TESEO database and defended in Spanish Universities between 1976 and 2022. The analyzes used have been descriptive and the prediction calculation was based on the methodology of the Holt- Winters. Main results: 18.75% of the theses defended belong to a University of Madrid. 75% of them are defended by graduates in Medicine. The theme of the theses is gender violence in 25%. 87.5% are doctors, but only 44% of women direct theses. The prediction for the future 24 years indicates that around 1 thesis will be generated per year. Main conclusion: Spanish research in gender clinical doctoral theses is scarce and masculinized.(AU)

El consumo colectivo de alcohol en jóvenes: un estudio cualitativo con perspectiva de género / O consumo coletivo de álcool em jovens: um estudo qualitativo com perspectiva de gênero / Binge drinking in young people: a qualitative study with a gender perspective

Objective. To explore the discourses and opinions about the collective consumption of alcohol with a gender perspective in university students. Methodology. Qualitative descriptive study. Information was collected through discussion groups in Seville in February and March 2019. 32 first-year nursing students participated. For data analysis, the Taylor & Bogdan steps were followed and a matrix was used for the categorization process. Four groups were made, aged between 18-24 years.Results. The following categories were obtained: type and form of consumption, social roles and behaviors.Conclusions. Gender differences are reflected in the students' discourse, highlighting the dissimilarities in behavior between genders and the greater guilt suffered by women. The female gender is the most noted for exceeding the limits and the most vulnerable in nightlife. This suggests the need to generate interventions aimed at redefining the stereotypes of the patriarchal model associated with gender and alcohol consumption, in order to minimize risk behaviors in youth leisure.(AU)

Objetivo. Explorar los discursos y opiniones acerca del consumo colectivo de alcohol con perspectiva de género en jóvenes universitarios. Metodología. Estudio cualitativo descriptivo. La recogida de información se realizó mediante grupos de discusión en Sevilla en febrero y marzo de 2019. Participaron 32 estudiantes de enfermería de primer curso. Para el análisis de los datos se siguieron los pasos de Taylor & Bogdan y se utilizó una matriz para el proceso de categorización. Se hicieron cuatro grupos, de edad entre 18-24 años. Resultados. Se obtuvieron las siguientes categorías: tipología y forma de consumo, roles sociales y conductas. Conclusiones. Las diferencias de género quedan plasmadas en el discurso del alumnado, destacando las disimilitudes de conducta entre géneros y la mayor culpabilidad que sufren las mujeres. El género femenino es el más señalado al exceder los límites y el más vulnerable en el ocio nocturno. Esto sugiere la necesidad de generar intervenciones orientadas a resignificar los estereotipos del modelo patriarcal asociados al género y al consumo de alcohol, para minimizar conductas de riesgo en el ocio juvenil.(AU)

Objetivo. Explorar os discursos e opiniões sobre o consumo coletivo de álcool com perspectiva de gênero em estudantes universitários. Metodologia. Estudo descritivo qualitativo. As informações foram coletadas por meio de grupos de discussão em Sevilha em fevereiro e março de 2019. Participaram 32 estudantes de enfermagem do primeiro ano. Para análise dos dados, seguiramse os passos de Taylor & Bogdan e utilizouse uma matriz para o processo de categorização. Foram constituídos quatro grupos, com idades compreendidas entre os 18 e os 24 anos. Resultados. Obtiveramse as seguintes categorias: tipo e forma de consumo, papéis sociais e comportamentos.Conclusões. As diferenças de gênero se refletem no discurso dos alunos, destacandose as diferenças de comportamento entre os gêneros e a maior culpa sofrida pelas mulheres. O gênero feminino é o mais destacado por ultrapassar os limites e o mais vulnerável na vida noturna. Isso sugere a necessidade de gerar intervenções que visem a redefinição dos estereótipos do modelo patriarcal associados ao gênero e ao consumo de álcool, a fim de minimizar comportamentos de risco no lazer juvenil.(AU)

Influence of Social Determinants of Health on the Quality of Life of Older Adults in Europe: A Sex Analysis.

Introduction: The global aging population poses challenges for society such as health inequalities among older persons and between genders. Objectives: To determine how Social Determinants of Health (SDH) influence the quality of life (QoL) of individuals over 50 years old in various European countries, taking a gender perspective in a longitudinal study. Materials and methods: Sample of 11,493 individuals from 13 European countries from Waves 5 (2013), 6 (2015), and 7 (2017) of the SHARE study. Instruments: CASP-12 (QoL), EURO-D (depression), SDH: gender, age, educational level, socioeconomic status, ethnicity, place of residence, and European region. Sociodemographic and clinical variables. Statistical analysis: Bivariate and multivariate mixed linear models. Results: The bivariate analysis showed higher economic hardship and lower education in women compared to men. The CASP-12 score was higher in men than in women. In the multivariate analysis, the variables associated with lower QoL scores among men and women from Wave 5 to Wave 7 were: (ß:-0.196, 95% CI: -0.345; -0.047) vs (ß:0.038, 95% CI: -0.122; 0.197); economic hardship; and the European region between South and North (ß: 2.709, 95% CI: 2.403; 3.015) vs men (ß: 2.224, 95% CI: 1.896; 2.551). Conclusions: The main SDH associated with poorer QoL were female gender, advanced age, economic hardship, educational level, and geographic location within Europe. Depression in women and in Southern Europe were associated with a decrease in QoL scores.

Gender differences in teenager bullying dynamics and predictors of peer-to-peer intimidation.

Thanks to several previous efforts, school peer-to-peer bullying is nowadays considered a major issue for educational dynamics, research, and policy. Specifically in the field of research, bullying assessment tools have been gaining ground in recent years. Among them, the School Bullying Questionnaire (CIE-A) stands out. This is a teenager-targeted scale assessing bullying dynamics from a three-factor approach (i.e., victimization, symptomatology, and intimidation). However, to date, no previous study using similar tools has followed a gender perspective, and this shortcoming may hinder the effectiveness of policies and actions to face school bullying. The core aim of this study was to examine the effect of gender on teenagers' bullying-related factors and intimidation outcomes. This cross-sectional study analyzed the data provided by a gender-weighted sample of 770 Spanish teenagers with a mean age of M = 14.25 (SD = 1.53) years. They responded to a questionnaire that included the CIE-A together with other variables theoretically related to bullying dynamics, such as risk perception, sensation seeking, life satisfaction, and family conflict. Apart from typical inter-group comparisons, data were analyzed through a multi-group structural equation modeling (MGSEM) approach. Regarding bullying experiences, male teenagers have shown greater involvement in both victimization (passive bullying) and intimidation (active harassment) behaviors. On the other hand, females self-reported greater symptomatology in passive bullying scenarios, despite being less frequently involved in them. Further, the MGSEM showed good fit values (RMSEA <.08; all incremental coefficients >0.90) and theoretical plausibility, also depicting a set of structural mechanisms differentially explaining active peer-to-peer intimidation behaviors across genders. For instance, while risk perception is a significant predictor of intimidation only among females, sensation seeking plays a predictive role among male teenagers, but not for their female counterparts. The results of this study suggest that teenagers' engagement in active bullying may be substantially different when approached from a gender perspective, finding key divergences in the variables that predict bullying-related behavioral outcomes. The outcomes of this research highlight the need to take into account gender differences, as well as extracurricular issues that influence intimidation dynamics, in potential bullying-related interventions.

Cribado de la retinopatía diabética mediante teleoftalmología en una zona básica de salud rural / Teleophthalmology-based diabetic retinopathy screening in a rural health basic area

Objetivo: Conocer la prevalencia de retinopatía diabética en una zona básica de salud rural, clasificándola según tipo y grado de severidad y conocer su relación con la presencia de otros factores de riesgo cardiovascular y con el sexo. Diseño: Estudio descriptivo transversal o de prevalencia. Emplazamiento: Zona básica de salud rural en España. Nivel de atención primaria. Participantes: Quinientos pacientes diabéticos mayores de 18 años. Mediciones principales: Estudio de la retina mediante retinografía bajo midriasis, según protocolo de la Joslin Vision Network, incorporando un centro de lectura para diagnóstico. Correlación de la existencia y gravedad de la retinopatía con los factores de riesgo cardiovascular –tabaquismo, hipertensión e hiperlipemia– y las características de la diabetes –tipo, tiempo de evolución, tratamiento, control metabólico y función renal–Resultados: Prevalencia encontrada del 16,4%, sin diferencias significativas entre sexos. Las variables tabaquismo e hipertensión estaban relacionadas con la existencia de retinopatía y la variable años de evolución de la diabetes con su existencia y su gravedad. El 9,6% de las personas afectadas fueron derivadas a oftalmología con carácter preferente, por retinopatía amenazante para la visión y el 6,8% de las personas estudiadas fueron derivadas por otras patologías oftalmológicas. Conclusiones: Es posible el seguimiento oftalmológico del 82% de la población diabética en atención primaria, implicando a sus profesionales y trabajando en equipo con el servicio de oftalmología. Es fundamental considerar esta enfermedad en el contexto global de la persona con diabetes, relacionándola con las otras complicaciones microvasculares y la enfermedad cardiovascular.(AU)

Objective: To investigate the prevalence of diabetic retinopathy in a rural health basic area, and to establish the type, the severity degree and the relationship with sex and with another cardiovascular risk factors. Design: Cross-sectional or prevalence descriptive study. Location: Rural health basic area in Spain. Primary health care level. Participants: 500 patients over 18 years old with diabetes. Main measurements: Study of the retina through retinography under mydriasis, according to the Joslin Vision Network protocol, with the incorporation of a diagnostic reading center. Correlation of the existence and severity of the retinopathy with the cardiovascular risk factors –smoking, hypertension and hyperlipidemia– and the characteristics of the diabetes –type, evolution time, treatment, metabolic control and renal function–.Results: The findings showed a 16.4% prevalence, with no significant differences between both sexes. The variables smoking and high blood pressure were related to the existence of retinopathy, and the variable years of diabetes evolution was correlated to both the existence and the severity of the retinopathy. In the study, 9.6% of the affected people were preferentially referred to the ophthalmologists because of sight-threatening retinopathy, and 6.8% of the people studied were referred due to other ophthalmological pathologies. Conclusions: It is possible to do the ophthalmological follow-up of 82% of the population with diabetes in primary health care, involving its professionals and team-working with the ophthalmologists. It is paramount to consider diabetic retinopathy within the global context of the person with diabetes, relating diabetic retinopathy with the other microvascular complications and cardiovascular diseases.(AU)

[Teleophthalmology-based diabetic retinopathy screening in a rural health basic area]. / Cribado de la retinopatía diabética mediante teleoftalmología en una zona básica de salud rural.

OBJECTIVE: To investigate the prevalence of diabetic retinopathy in a rural health basic area, and to establish the type, the severity degree and the relationship with sex and with another cardiovascular risk factors. DESIGN: Cross-sectional or prevalence descriptive study. LOCATION: Rural health basic area in Spain. Primary health care level. PARTICIPANTS: 500 patients over 18 years old with diabetes. MAIN MEASUREMENTS: Study of the retina through retinography under mydriasis, according to the Joslin Vision Network protocol, with the incorporation of a diagnostic reading center. Correlation of the existence and severity of the retinopathy with the cardiovascular risk factors -smoking, hypertension and hyperlipidemia- and the characteristics of the diabetes -type, evolution time, treatment, metabolic control and renal function-. RESULTS: The findings showed a 16.4% prevalence, with no significant differences between both sexes. The variables smoking and high blood pressure were related to the existence of retinopathy, and the variable years of diabetes evolution was correlated to both the existence and the severity of the retinopathy. In the study, 9.6% of the affected people were preferentially referred to the ophthalmologists because of sight-threatening retinopathy, and 6.8% of the people studied were referred due to other ophthalmological pathologies. CONCLUSIONS: It is possible to do the ophthalmological follow-up of 82% of the population with diabetes in primary health care, involving its professionals and team-working with the ophthalmologists. It is paramount to consider diabetic retinopathy within the global context of the person with diabetes, relating diabetic retinopathy with the other microvascular complications and cardiovascular diseases.

La relación profesionales-pacientes en tiempos de reforma. Un análisis socio-histórico con perspectiva de género del periódico ABC en los años ochenta / The doctor-patient relationship in times of reform. A socio-historical and gender analysis of the abc newspaper in the 1980s

El artículo analiza la representación de la relación médico-paciente en artículos publicados en el periódico ABC y explora la producción de significados de género del encuentro terapéutico durante los años ochenta, una etapa de renovación y cambios estructurales en la asistencia sanitaria española. El análisis histórico del discurso periodístico en ABC reveló la proyección social de una relación médico-paciente como acto humanitario y de amor, según los testimonios de los médicos que contribuyeron al debate en este medio y que, con frecuencia, mostraron su resistencia ante la reforma sanitaria y la preocupación por los cambios estructurales, así como por la organización y calidad de la asistencia. La crítica a la desnaturalización y burocratización de la relación médico-paciente fue secundada, a partir de 1984, por pacientes y periodismo especializado. Sus opiniones contrarias a la Ley de Sanidad de 1986 se agudizaron ante el amparo que la norma daba a los derechos de los pacientes. Las líneas discursivas conservadoras del ABC reflejaron la resistencia simbólica ante la reforma sanitaria, la moralización de la salud-enfermedad, la hegemonía de la profesionalización médica masculina y la invisibilización y subalternidad de las mujeres sanitarias.(AU)

The article analyzes the representation of the doctor-patient relationship in articles published in ABC newspaper and explores the production of gender meanings of the therapeutic encounter during the eighties, a period of renewal and structural changes in Spanish health care. The historical analysis of ABC journalistic discourse revealed the social projection of a doctor-patient relationship as a humanitarian act of love, according to the testimonies of the doctors. They frequently showed their resistance to health reform and concern for the changes in structural reorganization and quality of care. From 1984, patients and some journalists also criticize the bureaucratization of the doctor-patient relationship. The protection that the 1986 Health Law gave to the patients’ rights increased published opinions against the Health Law. The conservative discursive lines of the ABC reflected the symbolic resistance to health reform, the moralization of health-disease, the hegemony of male medical professionalization and the invisibility and subalternity of female health workers.(AU)

Polypharmacy and associated factors: a gender perspective in the elderly Spanish population (2011-2020).

Background: Few studies have examined the epidemiology of polypharmacy in non-institutionalized elderly adults with regard to sex differences. This study aimed to identify the prevalence of polypharmacy among people ≥65 years old residing in Spain, analyze trends in that prevalence from 2011/12 to 2020, describe the use of the medicines involved and study the possible relationship between polypharmacy and certain sociodemographic, health-related variables, as well as the use of care services by sex. Methods: A nationwide cross-sectional study with 21,841 non-institutionalized people ≥65 years old from the Spanish National Health Survey (2011/2012 and 2017) and the European Health Survey in Spain (2014 and 2020) was performed. We used descriptive statistics, performing two binary logistic regressions to determine the factors related to polypharmacy. Results: The prevalence of polypharmacy was 23.2% (women: 28.1%, men: 17.2%; p < 0.001). The most commonly consumed medicines were analgesics and tranquillizers, relaxants or sleeping pills in elderly women, compared with antihypertensives, antacids and antiulcer drugs and statins for elderly men. In both sexs, the positive predictors of polypharmacy included average, poor and very poor self-perceived states of health, people with overweight and obesity, being severely/non-severely limited due to a health problem, having ≥ three chronic conditions, visits to the family doctor and hospitalization. Among elderly women, negative predictors were alcohol intake, whereas in elderly men positive predictors were being 75-84 years old, being current smokers and having 1, 2 chronic conditions. Conclusion: Polypharmacy has a prevalence of 23.2%, with women accounting for 28.1% and men 17.2% of the total. Knowledge of positive and negative predictors of polypharmacy have important implications for public health efforts to develop or improve health guidelines and strategies for promoting the proper use of medication, particularly in the elderly population by sex.

La historia de vida de la enfermera Águeda Medina Soto como elemento clave dela relevancia de la cultura de los cuidados en la enfermería de Jaén / A história de vida da enfermeira Águeda Medina Soto como elemento chave darelevância da cultura do cuidado na enfermagem em Jaén / The life story of the nurse Águeda Medina Soto as a key element of the relevance of the culture of care in nursing in Jaén

In this proposal we present a feminist critical analysis of the importance that nurses haveplayed, being the life story of the nurse Águeda Medina Soto an example of her relevance in Jaén.In this sense, the methodology that facilitates the study of our recent past is life history, this beingpart of a critical-reflective intergenerational analysis, establishing cause-effect between personal experiences, society and Nursing. In addition, linking it with the gender perspective, it provides uswith another necessary analysis to reflect on how society was formed, the access and limitationsthat were presented to women of the time for incorporation into the nursing branch, in addition tothe difference structural and recognition of sex-gender roles between women and men who exercised these trades (nurses and interns respectively). The results obtained show the usefulness offered by the life history, to make visible the differences both structural, academic and sex-genderdifferentiated practices associated with nurses and practitioners. In turn, make visible the socialrelevance of nurses within the health field in the culture of care, through the case of nurse Águeda.(AU)

En esta propuesta presentamos un análisis crítico feminista de la importancia que hanjugado las enfermeras, siendo la historia de vida de la enfermera Águeda Medina Soto un ejemplo de su relevancia en Jaén. En este sentido, la metodología que nos facilita el estudio de nuestro pasado reciente es la historia de vida, siendo esta, parte de un análisis intergeneracional crítico-reflexivo, estableciendo causa-efecto entre las experiencias personales, la sociedad y la Enfermería. Además, enlazándolo con la perspectiva de género, nos presta otro un necesario análisis para reflexionarsobre cómo se conformaba la sociedad, el acceso y limitaciones que se presentaban a las mujeres dela época para la incorporación en la rama de enfermería, además de la diferencia estructural y dereconocimiento de los roles sexo-genéricas entre las mujeres y hombres que ejercían dichos oficios(enfermeras y practicantes respectivamente). Los resultados obtenidos muestran la utilidad queofrece la historia de vida, para visibilizar las diferencias tanto estructurales, académicas y prácticasdiferenciadas sexo-genéricas asociadas a las enfermeras y los practicantes. A su vez, visibilizar larelevancia social de las enfermeras dentro del ámbito sanitario en la cultura de los cuidados, a travésdel caso de la enfermera Águeda.(AU)

Nesta proposta apresentamos uma análise crítica feminista da importância que os enfermeiros têm desempenhado, sendo a história de vida da enfermeira Águeda Medina Soto um exemplo da sua relevância em Jaén. Nesse sentido, a metodologia que facilita o estudo do nosso passadorecente é a história de vida, fazendo parte de uma análise intergeracional crítico-reflexiva, estabelecendo causa-efeito entre experiências pessoais, sociedade e Enfermagem. Além disso, articulando-acom a perspectiva de gênero, nos fornece mais uma análise necessária para refletir sobre como seformou a sociedade, os acessos e limitações que se apresentavam às mulheres da época para incorporação ao ramo da enfermagem, além da diferença estrutural e reconhecimento dos papéis sexogênero entre mulheres e homens que exerciam esses ofícios (enfermeiros e estagiários, respectivamente). Os resultados obtidos mostram a utilidade oferecida pela história de vida, para tornar visíveis as diferenças estruturais, acadêmicas e práticas diferenciadas de gênero associadas a enfermeiros e profissionais. Por sua vez, visibilizar a relevância social dos enfermeiros da área da saúde nacultura do cuidado, através do caso da enfermeira Águeda.(AU)

Plasma acylcarnitines and gut-derived aromatic amino acids as sex-specific hub metabolites of the human aging metabolome.

Aging biology entails a cell/tissue deregulated metabolism that affects all levels of biological organization. Therefore, the application of "omic" techniques that are closer to phenotype, such as metabolomics, to the study of the aging process should be a turning point in the definition of cellular processes involved. The main objective of the present study was to describe the changes in plasma metabolome associated with biological aging and the role of sex in the metabolic regulation during aging. A high-throughput untargeted metabolomic analysis was applied in plasma samples to detect hub metabolites and biomarkers of aging incorporating a sex/gender perspective. A cohort of 1030 healthy human adults (45.9% females, and 54.1% males) from 50 to 98 years of age was used. Results were validated using two independent cohorts (1: n = 146, 53% females, 30-100 years old; 2: n = 68, 70% females, 19-107 years old). Metabolites related to lipid and aromatic amino acid (AAA) metabolisms arose as the main metabolic pathways affected by age, with a high influence of sex. Globally, we describe changes in bioenergetic pathways that point to a decrease in mitochondrial ß-oxidation and an accumulation of unsaturated fatty acids and acylcarnitines that could be responsible for the increment of oxidative damage and inflammation characteristic of this physiological process. Furthermore, we describe for the first time the importance of gut-derived AAA catabolites in the aging process describing novel biomarkers that could contribute to better understand this physiological process but also age-related diseases.

Acesso às práticas corporais/atividade física durante o ciclo da vida: relato de idosas aposentadas / Access to body practices/physical activity during the life cycle: report of retired elderly women

O objetivo foi verificar o acesso às práticas corporais/atividade física (PCAF) ao longo da vida de idosas aposentadas participantes de um grupo de PCAF. Trata-se de um estudo qualitativo com 16 mulheres idosas com idade entre 65 a 75 anos, selecionadas por conveniência, participantes de um grupo de PCAF de uma Unidade Básica de Saúde de Londrina, Paraná. As informações foram coletadas a partir de entrevistas com roteiro semiestruturado, conduzidas individualmente pelo profissional responsável pelo grupo. Os dados foram analisados por elementos da análise de conteúdo pelo sistema de categorias. Três categorias de análise foram consideradas: infância/adolescência; idade adulta; e terceira idade. Na infância/adolescência as mulheres relataram que não tiveram incentivo de seus pais, bem como não tiveram educação física na escola. Na fase adulta, a falta de tempo e de incentivo dos parceiros, além do desconhecimento de atividades ofertadas foram relatadas pelas mulheres. Somente a partir da terceira idade, especialmente após a aposentadoria, com a melhora da condição financeira e com o fato de terem maior tempo livre, as mulheres indicaram uma melhora no acesso, inclusive com a possibilidade da participação no grupo de PCAF. Em geral os resultados revelaram a dificuldade do acesso dessas mulheres às PCAF ao longo de suas vidas e reforçam a importância de ações e políticas públicas que busquem aumentar o incentivo e o acesso as PCAF ao longo da vida das mulheres

The objective was to verify the access to body practices/physical activity (BPPA) throughout the life of retired elderly women participating in a group of BPPA. This is a qualitative study with 16 elderly women aged between 65 and 75 years, selected for convenience, participants of a PCAF group at a Public Health Centre in Londrina, Brazil. The information was collected from interviews with a semi-structured script, which were conducted individually by the professional responsible for the group and analyzed from the content analysis by the category system. Three analysis categories were considered: childhood/adolescence; adulthood; and Old age. In childhood/adolescence, the women reported that they had no encouragement from their parents and had no physical education at school. In adulthood, lack of time and lack of encouragement from partners, in addition to the lack of knowledge of activities offered, were reported by women. Only from old age, especially after retirement, with the improvement of the financial condition and the fact of having more free time, the women indicated an improvement in the access to physical activity, including the possibility of participating in the PCAF group. In general, the results revealed the difficulty of these women's access to PCAF throughout their lives and reinforce the importance of public actions and policies that seek to increase incentives and access to PCAF throughout women's lives

Promoting empowerment and self-care in older women through participatory action research: Analysis of the process of change.

AIM: To generate and understand the process of change in the empowerment of women from 60 to 80 years old through a Participatory Action Research. SPECIFIC AIM: To analyse the women participants' experiences concerning empowerment and self-care. DESIGN: We use the Participatory Action Research approach (in its critical option) in the Socio-critical Paradigm and applying the Kemmis and McTaggart Model. METHODS: A group of 10 women participants from 60 to 80 years old was created and developed the Participatory Action Research from June 2019 to May 2020. This group was involved in 22 group sessions, individual interviews, reflective diaries and triangulation with quantitative data. RESULTS: Findings were interpreted based on the Gestalt Self Theory. Women generated changes in their empowerment based on three characteristics (self-determination, self-esteem and self-confidence) and, consequently, in their self-care. They did so according to two distinct patterns of behaviour: Leader women and follower women. The former took the lead in transforming their realities and the latter observed them and evolved in a slower and more reflective manner. These changes had an impact on the most individual level (inner world) and went beyond that barrier, modifying in turn their immediate surroundings and the social level (outer world). CONCLUSIONS: The group of older women began to consider their needs and consider themselves as important once they worked on their self-determination, self-esteem and self-confidence; we show these are key aspects to work on their empowerment and promote their self-care. IMPACT: The patterns of behaviour and dimensions of empowerment detected may help in future research designs and emancipatory community interventions in this population group.