Gender inequalities in science: Gaceta Sanitaria takes a step forward

Las desigualdades de género están presentes en la familia, el trabajo, los salarios, los recursos económicos, el uso del tiempo y el poder, de manera que las mujeres tienen una peor situación. La desigual distribución del poder se refleja también en las instituciones y las estructuras relacionadas con la ciencia, y a su vez se plasma en la producción científica. En este editorial se contextualiza y presenta una iniciativa promovida por el equipo editorial de Gaceta Sanitaria para responder a estas desigualdades a través de la nueva «Política de Gaceta Sanitaria para fomentar la igualdad de género en la publicación científica»

Decline in fertility induced by economic recession in Spain

OBJECTIVE: To describe trends in fertility in Spain before (pre-recession; 1998-2008) and during (recession period; 2009-2013) the economic crisis of 2008, taking into account women's age and regional unemployment in 2010. METHOD: The study consisted of a panel design including cross-sectional ecological data for the 17 regions of Spain. We describe fertility trends in Spain in two time periods, pre-recession (1998-2008) and recession (2009-2013). We used a cross-sectional, ecological study of Spanish-born women to calculate changes in fertility rates for each period using a linear regression model adjusted for year, period, and interaction between them. RESULTS: We found that compared to the pre-recession period, the fertility rate in Spain generally decreased during the economic recession. However, in some regions, such as the Canary Islands, this decrease began before the onset of the recession, while in other regions, such as the Basque country, the fertility rate continued to grow until 2011. The effects of the recession on the fertility rate are clearly observed in women aged 30-34 years. CONCLUSIONS: The current economic recession has disrupted the positive trend in fertility that began at the start of this century. Since Spain already had very low fertility rates, the further decline caused by the economic recession could jeopardize the sustainability of welfare-state systems

Gaceta Sanitaria in 2013: changes, challenges and uncertainties

El año 2013 ha sido un año de cambios para GACETA SANITARIA, entre los que destaca su publicación exclusivamente on-line desde el pasado mes de noviembre. Ha sido también un año de intensa actividad, que resumimos en esta nota editorial como viene siendo habitual en los últimos tiempos y siguiendo las recomendaciones del Comité Internacional de Editores de Revistas Biomédicas

Our experience in the Editorial Board of Gaceta Sanitaria. Especially, thank you!

Han pasado ya 6 años desde que el Comité Editorial actual de Gaceta Sanitaria empezó su labor, aunque parte de sus integrantes llevaban más tiempo en él. Gaceta Sanitaria nos ha acompañado nuestra vida diaria durante este periodo, ya que la dedicación necesaria para gestionar la revista es importante. Queremos aprovechar esta Nota editorial para despedirnos de las lectoras y de los lectores como equipo editorial y para revisar las principales aportaciones y problemas que hemos vivido, así como para hacer algunas reflexiones al respecto

Acceptance or decline of requests to review manuscripts: A gender-based approach from a public health journal

Peer review in the scientific publication is widely used as a method to identify valuable knowledge. Editors have the task of selecting appropriate reviewers. We assessed the reasons given by potential reviewers for declining a request to review, and the factors associated with acceptance, taking into account the difference in the sex of the reviewer. This is a descriptive study of the review requests from a public health journal (Gaceta Sanitaria) with an enforced gender policy. The dependent variables were requests, response to requests, reasons potential reviewers gave for declining requests and time to review. We carried out a descriptive analysis of these indicators and applied logistic regression to analyze factors (professional and research/review experience) associated with having done at least one review in 2014–2015. Results were stratified by sex. Journal editors sent 1,775 requests to 773 potential reviewers; 52.3% of whom reviewed at least one manuscript. Of the 396 declined requests (22.3%), the most common reasons were lack of time and of experience (88.1%). No differences were observed by sex. In the multivariate analysis, having reviewed for the journal in previous years showed the strongest association with acceptance. Specific analyses of data on requests reviewers may be useful for improving the acceptance rates to review. This study did not show gender differences in several indicators of the reviewing process

Trends in socioeconomic inequalities in mortality in small areas of 33 Spanish cities

Background: In Spain, several ecological studies have analyzed trends in socioeconomic inequalities in mortality from all causes in urban areas over time. However, the results of these studies are quite heterogeneous finding, in general, that inequalities decreased, or remained stable. Therefore, the objectives of this study are: (1) to identify trends in geographical inequalities in all-cause mortality in the census tracts of 33 Spanish cities between the two periods 1996–1998 and 2005–2007; (2) to analyse trends in the relationship between these geographical inequalities and socioeconomic deprivation; and (3) to obtain an overall measure which summarises the relationship found in each one of the cities and to analyse its variation over time. Methods: Ecological study of trends with 2 cross-sectional cuts, corresponding to two periods of analysis: 1996–1998 and 2005–2007. Units of analysis were census tracts of the 33 Spanish cities. A deprivation index calculated for each census tracts in all cities was included as a covariate. A Bayesian hierarchical model was used to estimate smoothed Standardized Mortality Ratios (sSMR) by each census tract and period. The geographical distribution of these sSMR was represented using maps of septiles. In addition, two different Bayesian hierarchical models were used to measure the association between all-cause mortality and the deprivation index in each city and period, and by sex: (1) including the association as a fixed effect for each city; (2) including the association as random effects. In both models the data spatial structure can be controlled within each city. The association in each city was measured using relative risks (RR) and their 95 % credible intervals (95 % CI). Results: For most cities and in both sexes, mortality rates decline over time. For women, the mortality and deprivation patterns are similar in the first period, while in the second they are different for most cities. For men, RRs remain stable over time in 29 cities, in 3 diminish and in 1 increase. For women, in 30 cities, a non-significant change over time in RR is observed. However, in 4 cities RR diminishes. In overall terms, inequalities decrease (with a probability of 0.9) in both men (RR = 1.13, 95 % CI = 1.12–1.15 in the 1st period; RR = 1.11, 95 % CI = 1.09–1.13 in the 2nd period) and women (RR = 1.07, 95 % CI = 1.05–1.08 in the 1st period; RR = 1.04, 95 % CI = 1.02–1.06 in the 2nd period). Conclusions: In the future, it is important to conduct further trend studies, allowing to monitoring trends in socioeconomic inequalities in mortality and to identify (among other things) temporal factors that may influence these inequalities.This article was partially funded by Plan Nacional de I + D + I 2008–2011 and Instituto de Salud Carlos III (ISCIII) –Subdirección General de Evaluación y Fomento de la Investigación- (Award numbers: PI081488, PI081978, PI080367, PI08/1017, PI080330, P08/0142, PI081785, PI080662, PI081713, PI081058, PI081340, PI080803, PI126/08), Fundación Canaria de Investigación Sanitaria FUNCIS 84/07 and by CIBER Epidemiología y Salud Pública (CIBERESP)

Trends in socioeconomic inequalities in preventable mortality in urban areas of 33 Spanish cities, 1996–2007 (MEDEA project)

Background: Preventable mortality is a good indicator of possible problems to be investigated in the primary prevention chain, making it also a useful tool with which to evaluate health policies particularly public health policies. This study describes inequalities in preventable avoidable mortality in relation to socioeconomic status in small urban areas of thirty three Spanish cities, and analyses their evolution over the course of the periods 1996–2001 and 2002–2007. Methods: We analysed census tracts and all deaths occurring in the population residing in these cities from 1996 to 2007 were taken into account. The causes included in the study were lung cancer, cirrhosis, AIDS/HIV, motor vehicle traffic accidents injuries, suicide and homicide. The census tracts were classified into three groups, according their socioeconomic level. To analyse inequalities in mortality risks between the highest and lowest socioeconomic levels and over different periods, for each city and separating by sex, Poisson regression were used. Results: Preventable avoidable mortality made a significant contribution to general mortality (around 7.5%, higher among men), having decreased over time in men (12.7 in 1996–2001 and 10.9 in 2002–2007), though not so clearly among women (3.3% in 1996–2001 and 2.9% in 2002–2007). It has been observed in men that the risks of death are higher in areas of greater deprivation, and that these excesses have not modified over time. The result in women is different and differences in mortality risks by socioeconomic level could not be established in many cities. Conclusions: Preventable mortality decreased between the 1996–2001 and 2002–2007 periods, more markedly in men than in women. There were socioeconomic inequalities in mortality in most cities analysed, associating a higher risk of death with higher levels of deprivation. Inequalities have remained over the two periods analysed. This study makes it possible to identify those areas where excess preventable mortality was associated with more deprived zones. It is in these deprived zones where actions to reduce and monitor health inequalities should be put into place. Primary healthcare may play an important role in this process.This work was partly supported by the FIS-FEDER projects PI080330, PI081713, PI081978, PI0463/2010, PI081017, PI081785, PI081058, PI080142, and the FUNDACIÓN CAJAMURCIA project FFIS/CM10/27

Lesiones atendidas en atención primaria en la Comunidad de Madrid: análisis de los registros en la historia clínica electrónica

Objetivo: Describir la incidencia de lesiones atendidas en atención primaria y analizar su distribución según el tipo de lesión por sexo y edad en la Comunidad de Madrid en el año 2011. Métodos: Estudio descriptivo transversal a partir de la historia clínica electrónica de atención primaria, del sistema sanitario público de la Comunidad de Madrid, en 2011. Se calcularon la incidencia de las lesiones, las tasas específicas de lesiones (fracturas, esguinces, heridas, quemaduras, lesiones por cuerpo extraño, intoxicaciones y contusiones) y las razones de tasas con un intervalo de confianza del 95%, todas estratificadas por sexo y edad. Resultados: En 2011 se registraron 707.800 episodios de lesiones (3,5% del total de los episodios atendidos en atención primaria). La mayoría afectaron a mujeres (54,0%) y a mayores de 34 años (58,0%). Las más frecuentes fueron las heridas en los hombres (35,3%) y las contusiones en las mujeres (30,6%). Globalmente, las mujeres presentaron tasas más altas de lesiones en edades avanzadas y los hombres se lesionaron más por debajo de los 15 años de edad. Por tipo de lesión, las tasas más altas de fracturas, quemaduras y contusiones se observaron en la población de mayor edad, las de lesiones por cuerpo extraño y heridas en la infancia, las luxaciones en jóvenes y las intoxicaciones en las edades extremas. Conclusiones: La vulnerabilidad especial de varones menores de 5 años y de las ancianas sugiere que las intervenciones tienen que dirigirse a las necesidades específicas de estos grupos