Vitamin D in pregnant women from extreme areas of latitude: review from midwifery / Vitamina D en gestantes en zonas extremas: revisión desde la matronería

Insufficient vitamin D levels occur in 88.1% of the worlds population, which constitutes a global public health problem. We analyzed vitamin D deficiency and suggested vitamin D supplementation in the perinatal health of pregnant women living in geographical areas higher than 40° south-north latitude according to reviews from the last three decades and identifying midwives role. The methodology used was a qualitative systematic review of full text studies, conducted in geographical areas higher than 40°N and 40°S. Descriptors such as: "deficiency", "vitamin D", "pregnancy", "causes", "perinatal outcomes" and "supplementation", and their respective descriptors in Spanish. The matrices were tabulated according to the modified PRISMA. Eight studies were obtained in English from the Northern Hemisphere only, mostly with good quality evidence and related to the role of midwifing according to the expert round. The results showed risks such as: origin of the pregnant woman, ethnicity, low sun exposure, obesity, socioeconomic status, and perinatal risks. No studies were found in pregnant women from the Southern Hemisphere or related to the role of the midwife in this area. In conclusion, midwifery should considerer the social determinants of vitamin D deficiency in pregnant women, especially those in extreme southern areas where incorporation of supplementation are suggested as a public policy.

Los niveles insuficientes de vitamina D se dan en el 88,1% de la población mundial, lo que constituye un problema de salud pública global. Se analizó la deficiencia y la sugerencia de suplementación de vitamina D en la salud perinatal de las gestantes residentes en áreas geográficas de latitud 40° sur-norte según revisiones de las últimas tres décadas identificando el rol de la matrona. La metodología utilizada fue una revisión sistemática cualitativa de estudios a texto completo, realizados en áreas geográficas mayores al paralelo 40°N y 40°S. Descriptores como: "deficiencia", "vitamina D", "embarazo", "causas", "resultados perinatales" y "suplementación", y sus respectivos descriptores en español. Las matrices se tabularon según el PRISMA modificado. Se obtuvo ocho estudios en inglés pertenecientes sólo al hemisferio norte, la mayoría con buena calidad de evidencia. Los resultados arrojaron factores como origen de la embarazada, etnia, baja exposición al sol, obesidad, nivel socioeconómico y riesgos perinatales. No se encontraron estudios en mujeres embarazadas del hemisferio sur o relacionados con el papel de la matrona. En conclusión, desde el ejercicio de la matronería se deben considerar los determinantes sociales de las mujeres embarazadas especialmente de zonas extremas del sur donde se sugiere investigación experimental e incorporación de la suplementación como política pública.

The Effects of Latitude and Temperate Weather on Vitamin D Deficiency and Women's Reproductive Health: A Scoping Review.

INTRODUCTION: We conducted a scoping review to analyze the effects and implications of vitamin D deficiency on female reproductive health during the last decade, considering temperate planetary zones and climate change impacts. METHODS: We used a qualitative methodology for a panoramic database review of PubMed, Web of Science, and Scopus covering articles from the last decade focused on populations living at latitudes higher than 40° N and 40° S. As descriptors, we used the phrases climate change, cholecalciferol or vitamin d3, pregnancy, and woman health and the Boolean operators AND and OR. We excluded letters to the editor, reviews, protocols, and clinical trials without human participants, as well as duplicate articles. RESULTS: We included 35 studies in English, the majority of which were from North America or Europe. No studies were found from the Southern Hemisphere or having any direct relation with climate change, although studies demonstrated that latitude and environmental factors affected vitamin D deficiency, which had an impact on pregnant women and their children. Supplementation guidelines were not well developed, and there was a lack of studies among at-risk groups of women (eg, darker skin, higher latitudes, immigrants) across the life span. DISCUSSION: Vitamin D deficiency is a global environmental problem that affects female reproductive health and depends on multiple environmental factors and human behavior. Therefore, we recommend consideration of environmental and sociocultural factors in public policy and clinical research and more research on the effectiveness of supplementation and fortification strategies. Health care professionals working in reproductive health need to generate actions for detection of, education on, and prevention of vitamin D deficiency among women across their life spans, considering the multicausality of the phenomenon, which includes environmental and climate factors in population health.

Gaps in sexual health research about women who have sex with women. A scoping review / Lagunas en la investigación sobre salud sexual en mujeres que tienen sexo con mujeres. Una revisión sistemática exploratoria

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

Objetivo: Conocer las características de los estudios centrados en mujeres que tienen sexo con mujeres (MSM) e identificar posibles lagunas en el interés sobre la salud sexual integral de las MSM. Método: Revisión sistemática exploratoria sobre salud sexual en MSM entre los años 2000 y 2019. Se excluyeron los estudios no centrados en salud sexual de MSM y se utilizó una herramienta web para asegurar el enmascaramiento. Se extrajo información sobre las características de los estudios y la calidad de la evidencia. Las categorías de análisis fueron: salud sexual integral, especificidad de prácticas sexuales en MSM y recomendaciones aportadas. Resultados: Se incluyeron 39 estudios, la mayoría transversales. Las lagunas identificadas fueron la falta de evidencia en salud sexual, la confusión entre orientación sexual y prácticas sexuales, la falta de interés específico en salud sexual integral y el enfoque de ciclo vital. Las recomendaciones se centraron en autocuidados de las MSM; intervenciones enfocadas a la práctica clínica, investigación, educación y prevención; y contribuciones desde un enfoque feminista sobre la salud sexual de las MSM. Conclusiones: Existen varias lagunas de conocimiento en la salud sexual de las MSM. Se destaca la necesidad de intervenir en la mejora del autocuidado y también de incluir estrategias específicas dirigidas a las características de estas mujeres, de acuerdo con sus realidades. (AU)

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

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

Tribunal Consitucional e identidad sexual: flor nueva de romances viejos / Constitutional Court and sexual identity: "New flower of old romances"

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Las calles, las noches, ¿también son nuestras? / The streets, the nights, are ours too?

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