Coronary heart disease prevention: views on women's gender-based perceptions and meanings

Impact of COVID-19 on longitudinal ophthalmology authorship gender trends

BACKGROUND

The COVID-19 pandemic increased the gender gap in academic publishing. This study assesses COVID-19's impact on ophthalmology gender authorship distribution and compares the gender authorship proportion of COVID-19 ophthalmology-related articles to previous ophthalmology articles.

METHODS

This cohort study includes authors listed in all publications related to ophthalmology in the COVID-19 Open Research Dataset and CDC COVID-19 research database. Articles from 65 ophthalmology journals from January to July 2020 were selected. All previous articles published in the same journals were extracted from PubMed. Gender-API determined authors' gender.

RESULTS

Out of 119,457 COVID-19-related articles, we analyzed 528 ophthalmology-related articles written by 2518 authors. Women did not exceed 40% in any authorship positions and were most likely to be middle, first, and finally, last authors. The proportions of women in all authorship positions from the 2020 COVID-19 group (29.6% first, 31.5% middle, 22.1% last) are significantly lower compared to the predicted 2020 data points (37.4% first, 37.0% middle, 27.6% last) (p < .01). The gap between the proportion of female authors in COVID-19 ophthalmology research and the 2020 ophthalmology-predicted proportion (based on 2002-2019 data) is 6.1% for overall authors, 7.8% for first authors, and 5.5% for last and middle authors. The 2020 COVID-19 authorship group (1925 authors) was also compared to the 2019 group (33,049 authors) based on journal category (clinical/basic science research, general/subspecialty ophthalmology, journal impact factor).

CONCLUSIONS

COVID-19 amplified the authorship gender gap in ophthalmology. When compared to previous years, there was a greater decrease in women's than men's academic productivity.

Perception of diabetes management and cardiovascular disease risk among men with type 2 diabetes: A qualitative study

Aim

The aim of this study was to explore the perception and understanding of men with type 2 diabetes about their illness control, risk for CVD and their adherence to healthcare management plans in Jordan.

Design

A qualitative descriptive design was used, recruiting a purposive sample of 13 men diagnosed with type 2 diabetes.

Methods

Data were collected between February and April 2019 through in-depth semi-structured interviews and analysed using content analysis.

Results

Data analysis revealed four themes: (a) Perception of diabetes control; (b) Perception of cardiovascular disease risk; (c) Coping with disease-imposed limitations; and (d) Information validation.

Conclusion

The study concludes that the perception of disease control does not necessarily coincide with actual disease control. Examining patients with diabetes perception and knowledge of their healthcare management and increased CVD risks is essential. An individualized culture and gender-sensitive health education and counselling involving spouses are recommended. Social media to disseminate scientific valid health instructions can enhance adherence.

How does gender influence the recognition of cardiovascular risk and adherence to self-care recommendations?: A study in Polish primary care

Background

Studies have shown a correlation between gender and an ability to change lifestyle to reduce the risk of disease. However, the results of these studies are ambiguous, especially where a healthy lifestyle is concerned. Additionally, health behaviors are strongly modified by culture and the environment. Psychological factors also substantially affect engagement with disease-related lifestyle interventions. This study aimed to examine whether there are differences between men and women in the frequency of health care behavior for the purpose of reducing cardiovascular risk (CVR), as well as cognitive appraisal of this type of risk. We also aimed to identify the psychological predictors of engaging in recommended behavior for reducing the risk of cardiovascular disease after providing information about this risk in men and women.

Methods

A total of 134 consecutive eligible patients in a family practice entered a longitudinal study. At initial consultation, the individual’s CVR and associated health burden was examined, and preventive measures were recommended by the physician. Self-care behavior, cognitive appraisal of risk, and coping styles were then assessed using psychological questionnaires. Six months after the initial data collection, the frequency of subjects’ self-care behavior was examined.

Results

We found an increase in health care behavior after providing information regarding the rate of CVR in both sexes; this increase was greater for women than for men. Women followed self-care guidelines more often than men, particularly for preventive measures and dietary advice. Women were more inclined to recognize their CVR as a challenge. Coping style, cognitive appraisal, age, level of health behaviors at baseline and CVR values accounted for 48% of the variance in adherence to self-care guidelines in women and it was 52% in men. In women, total risk of CVD values were most important, while in men, cognitive appraisal of harm/loss was most important.

Conclusions

Different predictors of acquisition of health behavior are encountered in men and women. Our results suggest that gender-adjusted motivation models influencing the recognition process need to be considered to optimize compliance in patients with CVR.

"I can't just follow any particular textbook": immigrants in cardiac rehabilitation

AIM

The study purpose was to examine how and under what circumstances immigrants combine diabetes self-care with cardiac rehabilitation recommendations.

BACKGROUND

Cardiac rehabilitation can improve and lengthen life in people with coronary heart disease as it promotes healthy physical and psychosocial behaviours and outcomes. This study is the first to examine the convergence of two common issues on participation: (1) the problems posed when cardiac rehabilitation patients must also contend with type II diabetes and (2) the experiences of immigrants in cardiac rehabilitation.

DESIGN

A critical ethnographic approach was employed.

METHODS

Two in depth interviews were conducted with 18 immigrants (eight men, ten women) enrolled in cardiac rehabilitation. Data were collected from 2008-2010.

FINDINGS

Threaded throughout immigrant participants' descriptions were biographical accounts of crossing geographical borders, establishing a sense of belonging in their adopted country and trying to feel 'at home' in cardiac rehabilitation. Participants described creative hybridization of transnationally informed knowledges and particularized practices to manage diabetes self-care and to reduce cardiac risk. Participants judiciously considered, assessed and blended knowledges from cardiac rehabilitation, experience with their own bodies and general 'wisdoms' passed on within their own and other immigrant communities.

CONCLUSION

These findings suggest that migration constitutes an important social positioning that contextualizes individual efforts to activate diabetes self-care and cardiac rehabilitation. Support to immigrants may improve when nurses recognize the significance of such experiences. Efforts are needed in practice and research to recognize and explore immigrants' creative efforts to engage in cardiac rehabilitation.

Design matters in secondary prevention: individualization and supervised exercise improves the effectiveness of cardiac rehabilitation

BACKGROUND

Hospital or centre-based cardiac rehabilitation (CR) can lengthen and improve life. However, most existing trials do not examine the effects of design characteristics. To examine the effects of these characteristics, this study compared an individualized cardiac rehabilitation programme to a standardized programme and examined what factors contributed most to programme effects.

DESIGN

A prospective cohort analysis was done comparing patients using an individualized centre-based cardiac rehabilitation programme (ICR) in a mixed urban-rural region of the west of Scotland, to a standardized cardiac rehabilitation programme (SCR) provided at the same site three years previously. Both inter- and intra-programme differences in outcomes were explored.

RESULTS

More patients were referred to ICR than SCR (749 versus 414 patients, p = 0.002) and the proportion of patients who subsequently attended was around 30% higher (p < 0.0001) although the overall rate of referral to ICR was lower (70% versus 62%, p = 0.002). ICR was associated with a reduction in hospital admission compared to SCR (HR: 0.664: 95% confidence interval (CI) 0.554 to 0.797). ICR patients also had significantly shorter hospitalizations (mean: 8.02 days versus 5.84 days, p < 0.05). ICR patients who attended at least 75% of the exercise sessions were significantly less likely to be hospitalized than individuals who partially attended (HR 2.39, 95% CI: 1.659 to 3.488) or did not participate in exercise sessions (HR 2.16, 95% CI: 1.482 to 3.143).

CONCLUSIONS

Individualized content and supervised exercise components are key design characteristics for improving outcomes from centre-based CR in clinically representative populations.

Women with heart failure are at high psychosocial risk: a systematic review of how sex and gender influence heart failure self-care

To improve patient support, it is important to understand how people view and experience Heart Failure (HF) self-care. This systematic review of qualitative studies included all published studies that examine the influence of sex and gender on HF self-care. A systematic search was done for papers (1995-2010) indexed in Ovid MEDLINE, Ovid Medline, Ovid EMBASE, Ovid PsycINFO, CSA Sociological Abstracts, OVID AARP Ageline, EBSCO Academic Search Complete, EBSCO CINAHL, EBSCO SocINDEX, ISI Web of Science: Social Sciences Citation Index and Science Citation Index Expanded, and Scopus. After screening of 537 citations, six qualitative studies identified that differences existed in perceptions of symptoms with women having less family involvement and psychosocial support around self-care. Moreover, women had considerably more negative views of the future, themselves and their ability to fulfill social self-care roles. Women with HF represent a highly vulnerable population and need more support for psychosocial wellbeing and self-care.

Women, environments and chronic disease: shifting the gaze from individual level to structural factors

INTRODUCTION

Chronic heart and respiratory diseases are two of the leading causes of morbidity and mortality affecting women. Patterns of and disparities in chronic diseases between sub-populations of women suggest that there are social as well as individual level factors which enhance or impede the prevention or development of chronic respiratory and cardiovascular diseases. By examining the sex, gender and diversity based dimensions of women's lung and heart health and how these overlap with environmental factors we extend analysis of preventive health beyond the individual level. We demonstrate how biological, environmental and social factors interact and operate in women's lives, structuring their opportunities for health and abilities to prevent or manage chronic cardiovascular and respiratory diseases.

METHODS

This commentary is based on the findings from two evidence reviews, one conducted on women's heart health, and another on women's lung health. Additional literature was also reviewed which assessed the relationship between environmental factors and chronic heart and lung diseases. This paper explores how obesogenic environments, exposure to tobacco smoke, and the experience of living in deprived areas can affect women's heart and respiratory health. We discuss the barriers which impede women's ability to engage in physical activity, consume healthy foods, or avoid smoking, tobacco smoke, and other airborne contaminants.

RESULTS

Sex, gender and diversity clearly interact with environmental factors and shape women's promotion of health and prevention of chronic respiratory and cardiovascular diseases. The environments women live in structure their opportunities for health, and women navigate these environments in unique ways based on gender, socioeconomic status, race/ethnicity and other social factors.

DISCUSSION

Future research, policy and programs relating to the prevention of chronic disease need to move beyond linear individually-oriented models and address these complexities by developing frameworks and interventions which improve environmental conditions for all groups of women. Indeed, in order to improve women's health, broad social and economic policies and initiatives are required to eliminate negative environmental impacts on women's opportunities for health.

Men and women managing coronary artery disease risk: Urban–rural contrasts

People's beliefs about health and making lifestyle changes associated with risk reduction and disease prevention can vary based on their gender and ethnocultural affiliation. Our objective was to describe and explain how gender and ethnocultural affiliation influence the process that people undergo when faced with making lifestyle changes related to their coronary artery disease (CAD) risk. A series of grounded theory studies were undertaken in Alberta, Canada, with men and women from five ethnocultural groups diagnosed with CAD. Here, we describe the cultural aspects associated with urban- and rural-living in 42 Euro-Celtic men and women. Data were collected through semi-structured, audio-recorded interviews and analysed using constant comparative methods. The core variable that emerged through the process was 'meeting the challenge'. There were three phases to the process of managing CAD risk: pre-diagnosis/event, liminal self, and living with CAD. Intra-personal, inter-personal, extra-personal, and socio-demographic factors influenced the participants' capacity to meet the challenge of managing their CAD risk. The influence of these factors was either direct or indirect through the intertwined elements of the participants' knowledge about CAD and perceived extent of necessary change. Each element of this process was influenced by the participants' gender and culture (urban- versus rural-living). When healthcare providers understand and work with the gender- and ethnoculturally based components that influence people's appraisal of their cardiac health and their decision-making, appropriate secondary prevention interventions and positive health outcomes are more likely to follow.

Gender, Ethnicity, and Cardiovascular Disease

Although the influence of gender and ethnicity on cardiovascular disease has been understudied, cardiovascular nurse researchers have contributed significantly to the existing body of knowledge. This article distinguishes between the constructs of "gender versus sex'' and "ethnicity versus race,'' acknowledging that the terms are often used interchangeably in research. A sampling of the substantial contributions of cardiovascular nurse researchers related to gender and ethnicity in the areas of symptoms of cardiovascular disease; risk factors and prevention; delay in seeking care, diagnosis, and treatment; recovery and outcomes; and cardiac rehabilitation is highlighted. Recommendations for future research include publishing research data by gender and ethnicity subgroups even though statistical comparisons may not be feasible, and increasing cardiovascular disease research in minority populations such as Asian Americans, Pacific Islanders, Native Americans, and Hispanics. Finally, we challenge cardiovascular nurse researchers to shift from the documentation of disparities toward designing and testing of interventions to eliminate health disparities.

Assessing nurse-patient interactions from a caring perspective: report of the development and preliminary psychometric testing of the Caring Nurse--Patient Interactions Scale

While there is a large body of literature regarding caring in nursing and some measurement tools addressing the concept have been developed, limitations of existing instruments constrain theory-driven research on nurse-patient interactions. The purpose of this paper is to describe the development and initial psychometric evaluation of the Caring Nurse-Patient Interactions Scale in a sample of 332 nurses and nursing students. The tool intended to facilitate research on the links between caring and patient outcomes. A content validity approach involving 13 expert nurses resulted in a 70-item tool sub-divided into 10 nursing carative factors. Alpha coefficients between sub-scales varied from .73 to .91 and sub-scales inter-correlations ranged from .53 to .89. Pearson correlation coefficients ranged from --.02 to .32 between the sub-scales and social desirability suggesting low to moderate bias. Results of the contrasted group approach partially supported the hypotheses while all differences were in the expected direction. Results suggest that the scale has strong potential for use in research, clinical and educational settings.

Perceived risk of heart attack: a function of gender?

TOPIC

The influence of gender on women's risk beliefs for heart attack.

PURPOSE

To inform healthcare providers how women's beliefs and attitudes contribute to treatment-seeking delay in the event of a heart attack, and to establish the importance of risk beliefs in women.

SOURCES

Published literature in MEDLINE and CINAHL computerized databases, reference lists of obtained articles.

CONCLUSIONS

Women's perceived risk beliefs for heart attack are influenced by the effects of media, cultural, and gender roles and the modeling of bias in health care. There is a need for healthcare providers to change their focus from acting on (etic) a patient to interacting within (emic) the belief systems of their patients to optimize positive outcomes.