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.

OBJECTIVE: To analyze the composition of the management structures of Spanish professional associations and scientific societies in the field of health in 2019 and compare them with the data obtained in 2014 and 2015.
METHODS: descriptive cross-sectional study. Scientific societies in the health field with state representation as of May 30, 2019 and data from professional associations with provincial, regional or state representation were collected as of June 1, 2019. They are compared to 2014 and 2015.
RESULTS: 259 professional associations and 163 scientific societies were analyzed. Both professional associations and scientific societies in the field of Health in 2019 exceed the percentage of 40% of balanced composition. The positions that have increased the most in percentage of women are those of vice-secretary (20,8%) or secretaries (9,3% in companies), vice-presidencies (8,8% and 11%) and members (6,4% and 4%). Presidency (2%) and dean (6%), the least.
CONCLUSIONS: It is necessary to continue with the efforts to advance in an equitable representation by sex.

This paper reflects on our decades-long cultural training experiences, offering details on training efforts we made and considers in hindsight interventions we wish we had been able to implement. The paper describes what we think could be necessary for organizational training/consultation to facilitate the transformation of organizations in the direction of social justice and the delivery of efficient and effective services to a community. We reflect on organizational training to promote cultural competence and social justice. We encourage readers to take the broadest possible perspective on the larger systems issues that tend to undermine such efforts, so they can better achieve their goals for organizational change.
En este artículo reflexionamos sobre nuestras experiencias de capacitación cultural desde hace décadas, ofrecemos detalles sobre los esfuerzos de capacitación que hicimos y tenemos en cuenta las intervenciones posteriores que hubiéramos querido implementar y no pudimos. También describimos lo que consideramos que podría ser necesario para que la consulta/capacitación organizativa facilite la transformación de las organizaciones en dirección de la justicia social y la prestación de servicios eficaces y efectivos para una comunidad. Reflexionamos sobre la capacitación organizativa para promover la competencia cultural y la justicia social. Animamos a los lectores a adoptar la perspectiva más amplia posible con respecto a los problemas de los sistemas más grandes que tienden a socavar dichos esfuerzos, de manera que puedan lograr mejor sus objetivos para el cambio organizativo.
本文回顾了我们数十年的文化培训经验, 详细介绍了我们所做的培训工作, 以及我们希望能够实施的事后干预措施。文中描述了我们认为组织培训/咨询可能需要什么, 以促进各组织向社会公正的方向转变, 并向社区提供高效和有效的服务。我们对组织培训进行了反思, 以促进文化能力和社会正义。我们鼓励读者从最广泛的角度来看待更大的系统问题, 这些问题往往是对这种努力起到破坏作用的, 这样做他们能够更好地实现组织变革的目标。.

Describe the risk of poverty and social exclusion in children aged 8-11 years from Gipuzkoa and Valencia (Spain), through AROPE (At Risk Of Poverty or Social Exclusion) indicators, and evaluate their associated factors in the INMA Project (Childhood and Environment).
Families in Gipuzkoa and Valencia (394 and 382, respectively) completed a questionnaire in 2015-2016. Low work intensity (LWI), at risk of poverty (RP) and material deprivation (MD) were estimated. AROPE consisted in meeting any of the previous sub-indicators. Socio-demographic, family and parental characteristics were considered. Frequencies, Venn\'s diagrams, and chi-square and Fisher tests were used in bivariate analysis and logistic regression in multivariate analysis.
For LWI, RP, MD and AROPE, prevalence of 2.5%, 5.6%, 2.3% and 7.2% were obtained in Gipuzkoa, and 8.1%, 31.5%, 7.8% and 34.7% in Valencia, respectively. In the multivariate analysis, the AROPE was associated in both areas with maternal social class and non-nuclear families. In Gipuzkoa, it was also related to maternal education. In Valencia, other factors were the mother\'s foreign origin, and paternal education and smoking.
There is higher AROPE prevalence in Valencia. Social class and family type were shared factors, but a differential pattern is observed in other social determinants. It is essential to implement social policies to reduce this axis of inequalities in health, especially in childhood.

Smoking patterns inform tobacco control policies. This study aimed to assess trends in smoking prevalence and associated socioeconomic factors in Portugal between 1987 and 2014.
We used data from National Health Interview Surveys (NHIS) conducted in 1987, 1995/96, 1998/99, 2005/06 and 2014/15. For each NHIS, we estimated gender-specific and age-standardized smoking prevalences, stratified by education, occupation, marital status and region. We constructed NHIS- and gender-specific logistic regression models, adjusting for the above-mentioned variables. We describe changes in smoking prevalence and inequalities in associated socioeconomic factors between 1987 and 2014.
In men, smoking prevalence (32.2% and 26.7%, respectively) and inequalities for all factors except for education decreased between 1987 and 2014. For women, inequalities decreased for region, age and occupation, and these changes occurred through increasing smoking prevalence in all groups. For marital status and education, inequalities were stable but smoking prevalence increased for all groups within these variables. In both sexes, the unemployed (adjusted odds ratio [aOR] 2014: men 2.33, women 2.76) and divorced (aOR 2014: men 2.12, women 3.18) consistently had the highest prevalences and aORs of smoking. For the first three NHIS higher aORs of smoking were observed among less-educated men and highly-educated women, while for the last two the higher odds were for the less-educated in both sexes.
Smoking trends among men showed decreasing prevalences and diminishing inequalities. For women, inequalities were stable but there was an overall increase in prevalence. The unemployed and divorced had the highest smoking prevalences in both sexes. Smoking prevention and cessation policies in Portugal should take into consideration inequalities, particularly among men, and increasing consumption among women.

Health promotion can contribute towards reducing inequality and ensuring equal opportunities, providing the means to enable the entire population to develop its maximum health possibilities. Women living in areas with social transformation needs (ASTN) are an especially vulnerable group due to the situation of material deprivation and social exclusion in which they live. Health promotion programmes for this group can bring about an improvement in their health. This paper describes the health promotion programme Socio-educational Groups of Primary Care for Women (SEGPC-W), and evaluates its implementation in ASTN in the city of Seville (Spain), as well as the benefits and difficulties of its development through a documentary analysis and interviews with participating professionals.

OBJECTIVE: To assess the modifying effect of marital status on social and gender inequalities in mortality from diabetes mellitus (DM) in Andalusia.
METHODS: A cross-sectional study was conducted using the Andalusian Longitudinal Population Database. DM deaths between 2002 and 2013 were analyzed by educational level and marital status. Age-adjusted rates (AARs) and mortality rate ratios (MRRs) were calculated using Poisson regression models, controlling for several social and demographic variables. The modifying effect of marital status on the association between educational level and DM mortality was evaluated by introducing an interaction term into the models. All analyses were performed separately for men and women.
RESULTS: There were 18,158 DM deaths (10,635 women and 7,523 men) among the 4,229,791 people included in the study. The risk of death increased as the educational level decreased. Marital status modified social inequality in DM mortality in a different way in each sex. Widowed and separated/divorced women with the lowest educational level had the highest MRRs, 5,1 (95%CI: 3,6-7,3) and 5,6 (95% CI:3,6-8,5) respectively, while single men had the highest MRR, 3,1 (95%CI: 2,7-3,6).
CONCLUSIONS: Educational level is a key determinant of DM mortality in both sexes, and is more relevant in women, while marital status also plays an outstanding role in men. Our results suggest that in order to address inequalities in DM mortality, the current focus on individual factors and self-care should be extended to interventions on the family, the community, and the social contexts closest to patients.

OBJECTIVE: To analyze economic inequality (absolute and relative) due to family income in relation to the occurrence of preterm births in Southern Brazil.
METHODS: Four birth cohort studies were conducted in the years 1982, 1993, 2004, and 2011. The main exposure was monthly family income and the primary outcome was preterm birth. The inequalities were calculated using the slope index of inequality and the relative index of inequality, adjusted for maternal skin color, education, age, and marital status.
RESULTS: The prevalence of preterm births increased from 5.8% to approximately 14% (p-trend<0.001). Late preterm births comprised the highest proportion among the preterm births in all studies, although their rates decreased over the years. The analysis on the slope index of inequality demonstrated that income inequality arose in the 1993, 2004, and 2011 studies. After adjustment, only the 2004 study maintained the difference between the poorest and the richest subjects, which was 6.3 percentage points. The relative index of inequality showed that, in all studies, the poorest mothers were more likely to have preterm newborns than the richest. After adjustment for confounding factors, it was observed that the poorest mothers only had a greater chance of this outcome in 2004.
CONCLUSIONS: In a final model, economic inequalities resulting from income were found in relation to preterm births only in 2004, although a higher prevalence of prematurity continued to be observed in the poorest population, in all the studies.

OBJECTIVE: Imaging diagnosis is essential for treatment planning in stroke patients. However, use of these techniques varies due to uncertainty about their effectiveness. Our purpose was to describe the use of CT and MRI in stroke and transient ischaemic attack (TIA) over 5years in hospitals belonging to the Canary Islands Health Service and analyse interhospital variability based on routinely collected administrative data.
METHODS: We gathered the minimum basic dataset (MBDS) from patients diagnosed with stroke or TIA between 2005 and 2010 in 4hospitals. Patients\' age, sex, procedures, secondary diagnoses, and duration of hospital stay were also recorded. We conducted a descriptive analysis of patient characteristics and a bivariate analysis using the t test and the chi square test to detect differences between patients assessed and not assessed with MRI. Logistic regression was used to analyse unequal access to MRI.
CONCLUSIONS: Our study included 10,487 patients (8,571 with stroke and 1,916 with TIA). The percentage of stroke patients undergoing a CT scan increased from 89.47% in 2005 to 91.50% in 2010. In these patients, use of MRI also increased from 25.41% in 2005 to 36.02% in 2010. Among patients with TIA, use of CT increased from 84.64% to 88.04% and MRI from 32.53% to 39.13%. According to our results, female sex, younger age, and presence of comorbidities increase the likelihood of undergoing MRI.

OBJECTIVE: The purpose of this work is to analyse the effects on informal caregiver\'s health and lifestyle when living with a dependent person at home. A comparison will be made between this situation and other situations involving commitment of time and energy, taking into account gender and age differences in each stage of the life cycle.
METHODS: Cross-sectional study analysing secondary data.
METHODS: The method used for collecting information is the computer assisted personal interview carried out in selected homes by the Ministry of Health, Social Services and Equality.
METHODS: The study included 19,351 participants aged over 25 years who completed the 2011-2012 Spanish National Health Survey.
METHODS: This research is based on demographic information obtained from a Spanish National Health Survey (2011/12). Using an empirical framework, the Logit model was select and the data reported as odds ratio. The estimations were repeated independently by sub-groups of age and gender.
RESULTS: The study showed that the health of people who share their lives with a dependent person is worse than those who do not have any dependent person at home (they are 5 times at higher risk of developing health problems). The study found that being a woman, advance age, low educational level and does not work, also has an influence. Being a caregiver reduces the likelihood of maintaining a healthy lifestyle through physical exercise, relaxation, or eating a balanced diet.
CONCLUSIONS: Living with a dependent person reduces the likelihood of maintaining healthy lifestyles and worsens the state of health of family members. Significant differences in gender and age were found.