Structure of communities in semantic networks of biomedical research on disparities in health and sexism / [Estructura de comunidades en las redes semánticas de la investigación biomédica sobre disparidades en salud y sexismo].

Introduction: As an initiative to improve the quality of health care, the trend in biomedical research focused on health disparities and sex has increased. Objective: To carry out a characterization of the scientific evidence on health disparity defined as the gap between the distribution of health and the possible gender bias for access to medical services. Materials and methods: We conducted a simultaneous search of two fundamental descriptors in the scientific literature in the Medline PubMed database: healthcare disparities and sexism. Subsequently, a main semantic network was built and some structural subunits (communities) were identified for the analysis of information organization patterns. We used open-source software: Cytoscape to analyze and visualize the semantic network, and MapEquation for community detection, as well as an ad hoc code available in a public access repository. Results: The core network corpus showed that the terms on heart disease were the most common among the descriptors of medical conditions. Patterns of information related to public policies, health services, social determinants, and risk factors were identified from the structural subunits, but with a certain tendency to remain indirectly connected to the nodes of medical conditions. Conclusions: Scientific evidence indicates that gender disparity does matter for the care quality in many diseases, especially those related to the circulatory system. However, there is still a gap between the medical and social factors that give rise to possible disparities by sex.

Introducción. Como una iniciativa para mejorar la calidad de la atención sanitaria, en la investigación biomédica se ha incrementado la tendencia centrada en el estudio de las disparidades en salud y sexismo. Objetivo. Caracterizar la evidencia científica sobre la disparidad en salud definida como la brecha existente entre la distribución de la salud y el posible sesgo por sexo en el acceso a los servicios médicos. Materiales y métodos. Se hizo una búsqueda simultánea de la literatura científica en la base de datos Medline PubMed de dos descriptores fundamentales: Healthcare disparities y Sexism. Posteriormente, se construyó una red semántica principal y se determinaron algunas subunidades estructurales (comunidades) para el análisis de los patrones de organización de la información. Se utilizó el programa de código abierto Cytoscape para el analisis y la visualización de las redes y el MapEquation, para la detección de comunidades. Asimismo, se desarrolló código ex profeso disponible en un repositorio de acceso público. Resultados. El corpus de la red principal mostró que los términos sobre las enfermedades del corazón fueron los descriptores de condiciones médicas más concurrentes. A partir de las subunidades estructurales, se determinaron los patrones de información relacionada con las políticas públicas, los servicios de salud, los factores sociales determinantes y los factores de riesgo, pero con cierta tendencia a mantenerse indirectamente conectados con los nodos relacionados con condiciones médicas. Conclusiones. La evidencia científica indica que la disparidad por sexo sí importa para la calidad de la atención de muchas enfermedades, especialmente aquellas relacionadas con el sistema circulatorio. Sin embargo, aún se percibe un distanciamiento entre los factores médicos y los sociales que dan lugar a las posibles disparidades por sexo.

Estructura de comunidades en las redes semánticas de la investigación biomédica sobre disparidades en salud y sexismo / Structure of communities in semantic networks of biomedical research on disparities in health and sexism

Resumen: Introducción. Como una iniciativa para mejorar la calidad de la atención sanitaria, en la investigación biomédica se ha incrementado la tendencia centrada en el estudio de las disparidades en salud y sexismo. Objetivo. Caracterizar la evidencia científica sobre la disparidad en salud definida como la brecha existente entre la distribución de la salud y el posible sesgo por sexo en el acceso a los servicios médicos. Materiales y métodos. Se hizo una búsqueda simultánea de la literatura científica en la base de datos Medline PubMed de dos descriptores fundamentales: Healthcare disparities y Sexism. Posteriormente, se construyó una red semántica principal y se determinaron algunas subunidades estructurales (comunidades) para el análisis de los patrones de organización de la información. Se utilizó el programa de código abierto Cytoscape para el analisis y la visualización de las redes y el MapEquation, para la detección de comunidades. Asimismo, se desarrolló código ex profeso disponible en un repositorio de acceso público. Resultados. El corpus de la red principal mostró que los términos sobre las enfermedades del corazón fueron los descriptores de condiciones médicas más concurrentes. A partir de las subunidades estructurales, se determinaron los patrones de información relacionada con las políticas públicas, los servicios de salud, los factores sociales determinantes y los factores de riesgo, pero con cierta tendencia a mantenerse indirectamente conectados con los nodos relacionados con condiciones médicas. Conclusiones. La evidencia científica indica que la disparidad por sexo sí importa para la calidad de la atención de muchas enfermedades, especialmente aquellas relacionadas con el sistema circulatorio. Sin embargo, aún se percibe un distanciamiento entre los factores médicos y los sociales que dan lugar a las posibles disparidades por sexo.

Abstract: Introduction: As an initiative to improve the quality of health care, the trend in biomedical research focused on health disparities and sex has increased. Objective: To carry out a characterization of the scientific evidence on health disparity defined as the gap between the distribution of health and the possible gender bias for access to medical services. Materials and methods: We conducted a simultaneous search of two fundamental descriptors in the scientific literature in the Medline PubMed database: healthcare disparities and sexism. Subsequently, a main semantic network was built and some structural subunits (communities) were identified for the analysis of information organization patterns. We used open-source software: Cytoscape to analyze and visualize the semantic network, and MapEquation for community detection, as well as an ad hoc code available in a public access repository. Results: The core network corpus showed that the terms on heart disease were the most common among the descriptors of medical conditions. Patterns of information related to public policies, health services, social determinants, and risk factors were identified from the structural subunits, but with a certain tendency to remain indirectly connected to the nodes of medical conditions. Conclusions: Scientific evidence indicates that gender disparity does matter for the care quality in many diseases, especially those related to the circulatory system. However, there is still a gap between the medical and social factors that give rise to possible disparities by sex.

Gender imbalance in executive management positions at the Mexican National Institutes of Health.

BACKGROUND: Around the world, there is a significant difference in the proportion of women with access to leadership in healthcare with respect to men. This article studies gender imbalance and wage gap in managerial, executive, and directive job positions at the Mexican National Institutes of Health. METHODS: Cohort data were described using a visual circular representation and modeled using a generalized linear model. Analysis of variance was used to assess model significance, and posterior Fisher's least significant differences were analyzed when appropriate. RESULTS: This study demonstrated that there is a gender imbalance distribution among the hierarchical position at the Mexican National Health Institutes and also exposed that the wage gap exists mainly in the (highest or lowest) ranks in hierarchical order. CONCLUSIONS: Since the majority of the healthcare workforce is female, Mexican women are still underrepresented in executive and directive management positions at national healthcare organizations.

Type 2 diabetes patients educated by other patients perform at least as well as patients trained by professionals.

BACKGROUND: Diabetes education can improve the quality of care of people with diabetes, but many organizations are not equipped to manage its implementation. Involving people with diabetes in the education process can overcome the problem. Thus, we compared clinical, metabolic and psychological outcomes in people with type 2 diabetes 1 year after attending a structured diabetes education programme implemented by professional educators versus the same programme implemented by trained peers with diabetes that also provided ongoing peer support. METHODS: People with type 2 diabetes (25-75 years) were randomly assigned to attend a 4-week structured diabetes education course delivered by professional educators (control) or previously trained peers (peer). Peers also received continuing psychological support, including examples on how to apply diabetes knowledge in daily life via weekly peer cellular phone calls and bimonthly face-to-face interviews in small groups (ten patients), using a structured questionnaire related to the patient's clinical, metabolic and psychological progress. Identical outcome data from both groups were used for follow-up. RESULTS: Both groups had a comparable positive effect on clinical, metabolic and psychological indicators immediately following the programme. Over the following year, peer-educated subjects had lower A(1C) and systolic blood pressure and showed higher adherence to physical activity and better control of hypoglycaemic episodes. CONCLUSION: The non-inferiority of the peer outcomes and the mentioned improvements in this group suggest that volunteer trained peer educators and ongoing support can be successful. This approach provides an effective alternative method of education, especially in areas with limited availability of professionals and economic resources.

[The UPLIFT study: future perspectives]. / Estudio UPLIFT: perspectivas futuras.

The natural history of chronic obstructive pulmonary disease (COPD) has classically been considered in terms of the rapid decrease in forced expiratory volume in 1 second (FEV(1)) and no other measure apart from smoking cessation has been demonstrated to modify the speed of this decrease. The evidence available from studies performed with tiotropium, of up to 1 year's duration, have shown that this anticholinergic drug can modify the course of COPD by acting on lung function, air entrapment, exacerbations, dyspnea and exercise tolerance, thus improving health status. This evidence has served as the basis for the design of the UPLIFT study (Understanding Potential Long-term Impacts on Function with Tiotropium), the main aim of which is to determine the effect of tiotropium on disease progression. This multicenter and multinational study has lasted for 4 years and almost 6,000 patients with COPD have participated. Data from this study are currently being analyzed and the results will shortly be made known. If the results are positive, it will be the first time that a pharmacological intervention has been able to modify the rate of FEV(1) decline, which would imply that the underlying disease is truly being modified. Positive data from the UPLIFT study would indicate that, together with smoking cessation, early treatment with tiotropium should be initiated at any stage of COPD, since both measures would have been proven to be able to modify the natural course of the disease. The probability of demonstrating maintenance of bronchodilation, as well as maintenance of the decrease in the number and severity of exacerbations found in studies conducted over a 1-year period, would represent a real change in what has been known to date about the natural course of COPD.

Estudio UPLIFT: perspectivas futuras / UPLIFT. The UPLIFT study: future perspectives

La evolución natural de la enfermedad pulmonar obstructiva crónica (EPOC) se ha considerado clásicamente en función de la tasa acelerada en el tiempo del deterioro del volumen espiratorio forzado en el primer segundo (FEV1) y, salvo el abandono del tabaquismo, ninguna otra medida se ha demostrado capaz de modificar la velocidad de dicho descenso. La evidencia disponible de los estudios realizados con tiotropio, de hasta un año de duración, han mostrado que este fármaco anticolinérgico puede modificar la evolución de la EPOC al actuar en la función pulmonar, el atrapamiento aéreo, las exacerbaciones, la disnea y la tolerancia al ejercicio, con lo que mejoraría el estado de salud. Estas evidencias han servido de base para el diseño del estudio UPLIFT (Understanding Potential Long-term Impacts on Function with Tiotropium), cuyo objetivo principal ha sido conocer el efecto del tiotropio sobre la progresión de la enfermedad. Este estudio multicéntrico y multinacional ha tenido una duración de 4 años y en él han participado casi 6.000 pacientes con EPOC(AU)

Actualmente se encuentra en la fase de análisis de datos y está próxima la comunicación de los resultados. Si del estudio UPLIFT se derivaran resultados positivos, sería la primera vez que una medida farmacológica es capaz de modificar la tasa de caída del FEV1, lo que implicaría que la enfermedad subyacente está siendo verdaderamente modificada. Los datos positivos del UPLIFT apoyarían que, junto al abandono del hábito tabáquico, se debería iniciar tratamiento con tiotropio en cualquier estadio de la EPOC, ya que ambas medidas se habrían mostrado capaces de modificar la evolución natural de la enfermedad. La probabilidad de demostrar el mantenimiento de la broncodilatación, así como el mantenimiento en el tiempo de la disminución del número y de la gravedad de las exacerbaciones encontrada en los estudios a un año, abre la puerta a un auténtico cambio en los datos conocidos hasta ahora sobre la evolución natural de la EPOC(AU)

The natural history of chronic obstructive pulmonarydisease (COPD) has classically been considered in terms ofthe rapid decrease in forced expiratory volume in 1 second(FEV1) and no other measure apart from smoking cessationhas been demonstrated to modify the speed of this decrease.The evidence available from studies performed withtiotropium, of up to 1 year’s duration, have shown that thisanticholinergic drug can modify the course of COPD byacting on lung function, air entrapment, exacerbations,dyspnea and exercise tolerance, thus improving healthstatus. This evidence has served as the basis for the design ofthe UPLIFT study (Understanding Potential Long-termImpacts on Function with Tiotropium), the main aim ofwhich is to determine the effect of tiotropium on diseaseprogression. This multicenter and multinational study haslasted for 4 years and almost 6,000 patients with COPDhave participated. Data from this study are currently beinganalyzed and the results will shortly be made known. If theresults are positive, it will be the first time that apharmacological intervention has been able to modify therate of FEV1 decline, which would imply that the underlyingdisease is truly being modified. Positive data from theUPLIFT study would indicate that, together with smokingcessation, early treatment with tiotropium should beinitiated at any stage of COPD, since both measures wouldhave been proven to be able to modify the natural course ofthe disease. The probability of demonstrating maintenanceof bronchodilation, as well as maintenance of the decrease inthe number and severity of exacerbations found in studiesconducted over a 1-year period, would represent a realchange in what has been known to date about the naturalcourse of COPD(AU)