Gaceta Sanitaria最新文献

Objective

To explore menstrual knowledge, menstrual management, the use of menstrual products, the prevalence of menstrual poverty and to assess the acceptability of a menstrual equity intervention among students in the fourth grade of compulsory secondary education in Catalonia (Spain).

Method

Post-intervention mixed-methods study (cross-sectional study and qualitative study with focus groups) with a critical and gender perspective. It was conducted between July 2022 and March 2023. Descriptive and bivariate statistical analyses stratified by gender were carried out. Qualitative data were analysed using thematic analysis.

Results

Women and people who menstruate rated the intervention favourably, while some men were reluctant. The intervention promoted the use of some reusable menstrual products, although some barriers to use menstrual cups were identified. Participants reported institutional barriers to menstrual management in the school setting and 19.4% stopped attending school during menstruation in the 6 months prior to the study. Between 10.9-16.4% reported menstrual poverty in the 6 months prior to the study, and 29,0% took actions to reduce the environmental impact of menstrual products.

Conclusions

This study highlights the need for co-designing menstrual interventions that consider gender dynamics and sexist attitudes with students, as well as targeting it to teachers. The provision of reusable menstrual products can be helpful in promoting their use, although accompaniment should be provided. In parallel, it is crucial to strengthen menstrual education, as well as to reduce menstrual poverty and school absenteeism during menstruation.

The Public Health System of Andalusia develops the Socio-Educational Groups Strategy (GRUSE), focused on promoting the health and emotional well-being of those who present somatic symptoms without organic cause in primary care health centers. This intervention began with groups of women and has been extended to groups of men, after verifying that the unemployment caused by the economic crisis, generated discomfort due to the loss of the “productive role”. A mixed methodology research has been designed to measure the effects of GRUSE in male participants. The quantitative design has longitudinal and quasi-experimental section, in which a battery of scales are used as instruments for collecting information. The qualitative design includes semi-structured interviews and focus groups. The objective of this article is to present the design of the research, with which it is expected to collect evidence of the impact of the intervention.

Objective

Estimate daily infections of COVID-19 during the first year of the pandemic in the Santiago Metropolitan Region (SRM) in Chile and Chile that are more realistic than those officially registered.

Method

Retrospective estimate of daily infections from daily data on COVID-19 deaths, a seroprevalence study, and the REMEDID (Retrospective Methodology to Estimate Daily Infections from Deaths) algorithm.

Results

In SRM, it is observed that: 1) the maximum peak of infections was more than double that registered in the official statistics; 2) such peak was reached on May 22 (95% CI: 20–24 May), 2022, that is, 24 days before the official date of the peak of infections; and 3) the first estimated contagion took place on January 28, 2020 (95% CI: January 21 to February 16), that is, 36 days before the official date. In Chile, the situation is similar. During the first wave SRM accounted for 70%–76% of those infected in Chile, while from August 2020 onwards it accounted for 36%–39%.

Conclusions

The official records of COVID-19 infections in SRM and Chile underestimated the real number of positives and showed a delay of about a month in the dynamics of infections. This is not an isolated situation, as it is known to have been the case in other countries as well. However, it is important to have reliable estimates for a correct modeling of the spread of the virus.

The Spanish public health system is overburdened. As a result, heath care professionals are showing symptoms of burnout, while private health services are expanding more than ever. As revealed by numerous strikes in recent years, health care professionals want better pay and work conditions and feel frustrated by their inability to give proper time and care to their patients. The institutional response from regional governments in Spain has been to remove the exclusivity clause that provided a salary bonus for physicians who worked entirely in the public sector; now all physicians receive this bonus, effectively promoting dual (public and private) practice. Although dual practice may increase the income of physicians and other health professionals, it poses several challenges that are analyzed in this paper. We also discuss alternative and more far-reaching policies that we believe should be implemented by the government in order to deal with the current crisis of the health system.

The problems posed by medical education in Spain are diverse. This paper analyzes the system currently used to select candidates who will be admitted to a public faculty of medicine in Spain and some issues arising from the unprecedented increase in both public and private medical schools in our country. The importance of generic competencies in today's medicine and the need to return to a core design in specialist training are other aspects that are discussed. The degree of development of advanced accreditation diplomas and areas of specific competence is also subject to analysis. Finally, the authors emphasize the importance of continuous professional development and the idea of professional recertification as a system that guarantees patients the quality of the care they receive.

Objective

Providing a general overview of the European Union's health workforce mobility under the challenges facing health systems regarding the supply of health workers.

Method

We use a descriptive method, based on the analysis of secondary data, qualitative and quantitative, concerning the European Semester from the European Union, complemented with statistical data from both the Union and some international organisations.

Results

The mobility of health professionals in the Union, associated to strong reliance on recruiting abroad and shortages due to emigration, was identified as a challenge in the European Semester process in a significant number of times during 2017-2023. The pandemic aggravated pre-existing shortages and the need to strike a balance between maintaining the resolution capacity of health systems while abiding by the free movement of health professionals. The information shows that Romania, Slovakia, Spain, Lithuania, Latvia, Portugal, Bulgaria, Greece, Croatia, Hungary, Italy, and Slovenia could be flagged with an “issuer profile”. Luxembourg, Ireland, Malta, and Sweden could be flagged with a “recipient profile”. We benefited from improvements in the information system concerning the Union's health workforce. Further advances regarding the harmonisation of health professions’ definition are needed, especially for nurses.

Conclusions

The European Union faces internal migrations of health professionals. Mobility is used as a solution to shortages. The pandemic aggravated pre-existing shortages bringing to the forefront the need to strike a balance between health objectives and internal market objectives. Member States are immersed in health reforms, some financed with European Funds. Promoting health workforce planning and forecasting would emerge as a necessary action, including improving harmonised information. Drawing in a systematic way on the available information from the European Semester reports may provide some clues to give answers to policymaking concerning health professionals’ mobility.

Objective

To examine the presence of women in the organs of the Interterritorial Council of the Spanish National Health System (CISNS).

Method

Annual reports of the CISNS from 2005 to 2022 were analyzed. Artificial intelligence was used to assign gender, and percentages of women's participation were calculated. Temporal evolution, vertical segregation, and horizontal segregation were analyzed.

Results

Between 2005 and 2022, there were 14,308 participations in 85 organs, with 52% women, rising from 42% in 2005 to 61% in 2022. There was a higher participation of women in propositional organs (54%), followed by executive ones (50%), and plenary sessions (40%). The General State Administration had 61% women compared to 48% in autonomous communities. Women's participation varied by topic, being higher (82%) in gender violence and lower (35%) in inspection.

Conclusions

Although there is a slight reduction in the participation gap between women and men, inequalities persist. Women have less presence in higher hierarchical levels (plenary sessions), maintaining vertical segregation. Additionally, women's representation in certain topics remains low, maintaining horizontal segregation. Concrete actions must be taken to continue advancing equality and improving health outcomes in society as a whole.

Objective

To delve deeper from a gender perspective into the lessons learned during the COVID-19 pandemic to address future health crises.

Method

Study with key informants with experience in public health and gender from the Ministerio de Sanidad, ministries of the autonomous communities, Institut Català de la Salut, Hospital de La Princesa, Escuela Andaluza de Salud Pública and Universidad País Vasco. Source of information: individual open-ended questionnaire on health and health inequalities/gender inequalities related to COVID-19. After presenting the findings, the key informants group discussed them in a meeting until reaching a consensus on the lessons learned.

Results

The lack of clinical statistics by sex could compromise epidemiological surveillance, losing the opportunity to characterize the disease. The performance of essential services fell more on women, exhausting them with double and triple shifts; with the differences according to sex in the clinical presentation of COVID-19, and the criteria for hospitalization/admission to the intensive care unit, their access to health care decreased. Increased: gender violence and mental health problems; delaying recognition of the second effects of vaccines in women; partially due to information biases in clinical trials. The gender perspective was lacking in academic, healthcare, and health management areas.

Conclusions

Women's gender dimensions determined their higher frequency of COVID-19 and played a fundamental role in its control. Broadly considering the lessons learned will strengthen prevention systems and be able to provide effective responses to future health crises.