Laura Medina-Perucha

Menstrual health plays a crucial role in health-related quality of life (HRQoL). However, there is a gap addressing HRQoL in relation to broader aspects of

Introduction: Healthcare professionals (HCP) encounter a multitude of challenges regarding the utilisation of medicines, vaccines, and alternative therapies in pregnant and breastfeeding women (PBW). Objective: The objective of this study was to explore the experiences, beliefs, and attitudes of HCP toward prescribing medicines, vaccines, and alternative therapies during pregnancy and breastfeeding in Catalonia, Spain. Methods: This study employed a qualitative methodology, guided by a gender-based perspective. Three discussion groups were conducted, with the participation of 21 HCP during February 2024. Sampling was intentional, purposive designed to ensure discourse diversity. Recruitment was conducted through key contacts in public primary healthcare centres, sexual and reproductive health care centres, hospital settings in Catalonia, using snowball techniques. The data were analysed using thematic analysis. Results: The challenges encountered by HCP who provide care to PBW are numerous and vary depending on the healthcare speciality area. Family physicians and nurses identified a lack of training in obstetrics as a factor contributing to difficulties in prescribing medicines. Midwives emphasised the importance of monitoring and follow-up during pregnancy, especially in cases where an adaptation of medication is required, while gynaecologists drew attention to the challenges posed by an increase in medication avoidance. HCP expressed concerns about the safety of the COVID-19 vaccine, as opposed to the greater safety of evidence of pertussis and influenza vaccines. The use of alternative therapies may lead to potential complications during consultations, as some users do not disclose their use. Conclusions: This study underscores the challenges encountered by HCP in drug prescriptions, complementary medicine, and vaccination during pregnancy and breastfeeding, considering HCP differences between specialities. Additionally, the study emphasises the difficulties associated with dual follow-up cases and the significance of establishing trusting relationships with users and shared decision-making processes or a good medication adherence. Patient or Public Contribution: HCP have participated sharing their experience in prescribing medication and recommendations on vaccines and alternative medicine. The results of this study can be used to effect change in the practice of HCP.

Objectives: Clinical decision-support systems are computer-based tools to improve healthcare decision-making. However, their effectiveness depends on being positively perceived and well understood by healthcare professionals. Qualitative research is particularly valuable for exploring related behaviors and attitudes. This study aims to explore experiences of family physicians and nurses concerning the visualization, utility and understanding of the non-valvular atrial fibrillation clinical decision-support system (CDS-NVAF) tool in primary care in Catalonia, Spain. Methods: We performed a qualitative study, taking a pragmatic utilitarian approach, comprising focus groups with healthcare professionals from primary care centers in the intervention arm of the CDS-NVAF tool randomized clinical trial. A thematic content analysis was performed. Results: Thirty-three healthcare professionals participated in three focus groups. We identified three key themes: (1) barriers to tool adherence, encompassing problems related to understanding the CDS-NVAF tool, alert fatigue, and workload; (2) using the CDS-NVAF tool: differences in interpretations of Time in Therapeutic Range (TTR) assessments, and the value of TTR for assessing patient risk; (3) participants’ suggestions: improvements in workflow, technical aspects, and training in non-valvular atrial fibrillation management. Conclusions: Healthcare professionals endorsed a clinical decision-support system for managing oral anticoagulation in non-valvular atrial fibrillation patients in primary care. However, they emphasized the view that the CDS-NVAF requires technical changes related to its visualization and better integration in their workflow, as well as continuing training to reinforce their theoretical and practical knowledge for better TTR interpretation.

Menstrual inequity refers to the systematic and avoidable differences experienced by women and people who menstruate, based on having a menstrual cycle and menstruating. Given the paucity of prior research examining the impact of menstrual inequity on health, a scoping review was conducted to explore and map out the menstrual inequities and their association with health outcomes in women and people who menstruate within the published academic literature. Two searches were conducted in May 2022 and March 2024 in PubMed and Scopus. Academic literature published until December 2023 was included. Following the screening process, 74 articles published between 1990 and 2023 were included in the review. Results were then synthesised through narrative analysis and organised into nine categories. A range of both physical and emotional health outcomes were documented to be associated with menstrual inequity. Urinary tract infection, reproductive tract infection, and other genital discomforts (e.g. itching) were linked to certain menstrual discomforts (e.g. dysmenorrhea) as well as a lack of access to menstrual products, menstrual management facilities and/or menstrual information. The emotional health outcomes, especially anxiety, distress and depression, were salient and were shown to be related to menstrual stigma, the lack of menstrual information and the limited access to menstrual-related healthcare. The majority of the included studies were focused on menstrual management, being one of the most addressed themes concerning menstruation, and the health outcomes were mainly reproductive tract infection and emotional/mental health. Expanding the range of health outcomes studied will strengthen research and inform policy. Further research is needed to better understand the complex association between menstrual inequities and other potential health outcomes.

Background: Interventions based on testing and communication training have been developed to reduce antibiotic prescribing in primary healthcare (PHC) for the treatment of acute lower respiratory infections (ALRTIs). However, research based on the experiences of PHC clinicians participating in ALTRIs interventions to reduce antibiotic prescribing in Barcelona is scanty. Aim: This study aimed to explore the perceptions and experiences of clinicians (physicians and nurses) on an intervention to reduce antibiotic prescription in PHC in Barcelona (Spain). This intervention was a randomised controlled study (cRCT) based on three arms: 1) use of a C-reactive protein (CRP) rapid test; 2) enhanced communication skills; and 3) combination of CRP rapid test and enhanced communication skills. In addition, the study aimed to explore the impact of COVID-19 on the detection of ALRTIs. Methods: This qualitative study used a socio-constructivist perspective. Sampling was purposive. Participants were selected based on age, sex, profession, intervention trial arm in which they participated, and the socioeconomic area of the PHC where they worked. They were recruited through the healthcare centres participating in the study. Nine participants (7 women and 2 men) participated in two focus groups, lasting 65–66 min, in September–October 2022. Framework analysis was used to analyse the data. Findings: Three themes were identified: ‘(The intervention) gave us reassurance’: intervention experiences among health professionals. This theme includes accounts of clinicians’ satisfaction with the intervention, particularly with CRP testing to support clinical diagnoses; ‘We don’t have time in primary healthcare’: structural and community resources in healthcare services. This theme encompasses clinicians’ experiences on healthcare pressures and PHC organisational structures barriers to PHC interventions; and ‘I only did three CRP’: impact of COVID-19 pandemic on the intervention. The last theme focuses on the impact of the COVID-19 pandemic on the intervention’s implementation. Conclusions: CPR testing and promoting communication skills can be useful tools to support clinical decisions for ALRTIs. Structural barriers (e.g., healthcare pressures) and social inequities amongst service users were acknowledged as the main barriers for the implementation of ALRTIs interventions.

There is a paucity of research exploring how men and individuals who do not menstruate comprehend menstrual health and equity. The objective of this study was to explore the conceptualization and attitudes towards menstruation and the menstrual cycle among men and people who do not menstruate aged between 18 and 55 in the Barcelona area. Furthermore, it examined their involvement in menstrual health and equity initiatives. This qualitative study employed a feminist critical perspective. Seventeen semi-structured photo-elicitation interviews were conducted. It was frequently observed that menstrual education was often inadequate and biomedical in nature. Participants often acquired knowledge about menstruation through interactions with menstruating sex-affective partners. Menstruation was generally perceived negatively, and menstrual taboo and stigma were apparent. Some participants expressed the view that men should raise awareness of a more positive stance on menstruation. The findings of this study highlight the need for structural menstrual policies and community programs where men and people who do not menstruate are involved.