Rodrigo López Barreda

Background: Access to timely and appropriate care for children with congenital heart disease (CHD) remains highly inequitable in low- and middle-income countries (LMICs). Objectives: This systematic review synthesizes recent evidence on barriers to healthcare access for pediatric CHD and applies the SHEL human factors framework to analyze system-level determinants. Design: This updated systematic review extends a prior analysis, applying PRISMA guidelines. Search was conducted in PubMed/MEDLINE, Scopus, and Web of Science. Regional trends were mapped via WHO classifications. Results: Most studies reported barriers related to environmental factors, followed by workforce limitations, infrastructure constraints, and policy or organizational deficiencies. Many obstacles originated at the primary care level, contributing to delayed diagnosis and referral. Although all regions exhibited barriers across SHEL domains, their relative distribution varied by region. Conclusion: These findings highlight that improving CHD outcomes in LMICs requires integrated health system strengthening across levels of care.

BACKGROUND: Burnout among healthcare providers can adversely impact their performance and patient care. Vital Anaesthesia Simulation Training (VAST) Wellbeing is a 1-day course designed to promote personal and professional well-being and to reduce burnout for healthcare providers in low-resource settings. VAST Wellbeing has demonstrated benefits in this context but has never been evaluated in a conflict zone. This study assessed the influence of VAST Wellbeing among healthcare workers practicing in the EMERGENCY-NGO Salam Centre for Cardiac Surgery in Sudan amidst a conflict. METHODS: This mixed-methods study was designed to explore participants’ experience of VAST Wellbeing offered in Sudan to learn about benefits and challenges to this training in a conflict zone. Our team used in-depth qualitative interviews with purposively selected course participants. Perceived social stigma of receiving mental health support and attitudes toward help seeking for mental health were also quantitatively assessed using the Stigma Scale for Receiving Psychological Help and the General Help-Seeking Questionnaire, respectively. RESULTS: Sixty healthcare providers attended the course; 35 completed quantitative measures, and 12 were interviewed. Stigma for receiving mental health support decreased comparing median [interquartile range {IQR}] precourse to postcourse scores (8.0 [6–9] versus 6.0 [3–8], P =.005). Willingness to seek help in the event of a mental health concern significantly increased when comparing precourse to postcourse scores (3.4 [2.6 to 3.9] versus 4.6 [3.9 to 5.0], P >.001). Three major themes and nine subthemes were identified during qualitative data analysis. Theme 1: The influence of conflict manifested as participants reporting persistent fear and stress and that the workplace was extremely strained. Theme 2: In social context it was noted that the training reduced social stigma, strengthened of a sense of community, and led to subtle changes in the workplace environment. Theme 3: The training contributed to new learning and practices , such as greater recognition of burnout and engaging in personal well-being practices. Acceptance of mindfulness was mixed, albeit with recognition of its positive effects. Despite many contextual challenges, participants reported the course to be needed and relevant. CONCLUSION: The findings suggest that VAST Wellbeing was pertinent and impactful in a conflict zone. It helped to foster a stronger sense of community, reduce stigma around mental health discussions, increase the acceptability of help-seeking, and encourage participants to adopt strategies for self-care and well-being.

Short-Term Medical Missions (STMMs) are healthcare initiatives that serve underserved populations in low- and middle-income countries, typically lasting from one to four weeks. Often driven by altruistic aims—including religious and humanitarian motivations—these missions raise significant ethical concerns related to effectiveness, sustainability, and the potential to unintentionally harm vulnerable communities. This article offers an interdisciplinary contribution by bridging clinical experience with theories of justice and Christian spirituality. Using a theoretical-normative methodology, it applies four ethical frameworks—Utilitarianism, Contractualism, Cosmopolitanism, and Catholic Social Teaching—to the ethical examination of STMMs. The analysis unfolds in two stages: first, a comprehensive review of key academic literature and foundational texts; second, the application of each framework to a composite case study drawn from the author’s academic and professional experience. While each framework offers valuable insights, all reveal important limitations when confronted with complex real-world dilemmas. To navigate such ethical ambiguity, the article proposes Ignatian discernment as a complementary approach—not a competing framework, but a structured practice already used in decision-making under uncertainty. Applied to STMMs, discernment draws on the strengths of the four frameworks to help practitioners weigh competing values, engage local partners, and make context-sensitive decisions in settings marked by asymmetry, urgency, and cultural difference.

This study aims to contribute to the reflection on the impact of fraud in medical publications and to offer suggestions to health science educators to limit the potential harm of fraudulent publications concerning scientific literature integrity and patient wellbeing. We analyze the retractions of Joachim Boldt and Yoshitaka Fujii, the two researchers with the most cases of retractions due to fraud. The Web of Science and Retraction Watch Database were consulted in December 5th 2023. We also carried out a bibliographic search on scientific integrity and critical thinking to identify ways for preventing fraud and mitigating its consequences. 194 studies were obtained for Boldt and 151 for Fujii. These studies generated 5,450 citations for Boldt and 2,245 for Fujii. After filtering to include only citations from systematic reviews, 734 systematic reviews were found to have cited Boldt's retracted studies, while 140 systematic reviews cited Fujii's studies. The literature reports that several non-technical skills linked to leadership and management are important for researchers, such as effective communication, teamwork, coaching, task sharing, strategic planning, budgeting, personnel selection and evaluation, and situational awareness. All actors must work to foster a culture of integrity at all stages of the research process to prevent harm to patients. It is essential to identify appropriate pedagogical strategies to influence the skills, attitudes and behaviors of future professionals. Developing integrity and critical judgment may require the use of different methodological approaches to those traditionally used in the medical sciences.

Objetivo. Describir el proceso de implementación de una base de datos para cirugía cardíaca en pacientes con cardiopatías congénitas en el Instituto Nacional Cardiovascular (INCOR) en Perú, adaptada a la nomenclatura estandarizada de la Society of Thoracic Surgeons y presentar los resultados clínicoquirúrgicos en morbilidad y mortalidad, en el marco de una atención multidisciplinaria integral. Materiales y métodos. Estudio observacional, prospectivo desarrollado en tres fases: viabilidad, construcción de la base de datos y recopilación prospectiva. Se adaptaron variables al contexto institucional; el proceso incluyó prueba piloto, planificación estratégica, capacitación multidisciplinaria, asignación de roles, monitoreo y análisis estadístico periódico. Resultados. Se registraron 500 pacientes consecutivos entre mayo de 2022 y julio de 2023. Los defectos septales fueron la principal indicación quirúrgica; las complicaciones más frecuentes incluyeron disfunción cardíaca y arritmias. La mortalidad hospitalaria fue del 7,6 %. La base de datos permitió integrar la evaluación nutricional y odontológica preoperatoria. Si bien el 27,2% de los formularios en la base de datos estaba completo, el resto presentó limitaciones como datos faltantes y la necesidad de verificación adicional de la información entre módulos. Conclusión. Es factible implementar un registro de cirugía cardíaca congénita en Perú con recursos limitados. Este sistema permite identificar áreas críticas para mejorar la atención y optimizar los resultados clínicos, estableciendo una base para futuras iniciativas de mejora en la calidad asistencial.

CHD includes a wide range of cardiac disorders present at birth. If appropriate care is delivered in time, the prognosis is relatively good. However, in many parts of the world, access to healthcare continues to be a problem for these patients, particularly in low- and middle-income countries. The aim of this study was to synthesise and analyse the available evidence to provide a deeper understanding of this problem. The literature search identified 1578 articles, and the final selection included 57 articles. Using the patient-centred healthcare access framework for identifying facilitators and barriers, issues were found at all levels of the health provision pathway, of which diagnosis, referral systems, lack of qualified institutions/health professionals, financing, inappropriate health insurance, and quality of care stand out. More evidence is needed to analyse the effect of potential barriers linked to acceptability. Given the nature of the barriers that this population faces, solutions depend on the health system and the local context.

People are intrinsically relational beings and this need to interact is channelled into the establishment of communities, whose organization is often formalized into institutions. An opposition between both types of groups has been raised in the literature. This article seeks to critically analyze the relationship between communities and institutions, based on Christian social ethics, political philosophy, and social sciences through a bibliographic exploration and a transdisciplinary discussion. The concepts of community and institution are analyzed and citizenship connections with both concepts are discussed, considering two different traditions of citizenship, and its relationship with democratic culture and community building. To conclude, the concept of binding citizenship as a bridge between communities and institutions is proposed, and solidarity and liberty are considered as two principles that become integrated and can coexist in communities and institutions.

Background: Mortality from congenital heart disease has decreased considerably in the last two decades due to improvements in overall health care. However, there are barriers to access to healthcare in Latin America for this population, which could be related to factors such as healthcare system, policies, resources, geographic, cultural, educational, and psychological factors. Understanding the barriers to access to care is of paramount importance for the design and implementation of policies and facilitate the provision of care.Aim: The aim of the study was to investigate the perception of barriers to access to health care on parents/guardians of children with congenital heart disease in selected Latin American countries.Methods: A descriptive, cross‐sectional study, in which parents/guardians or primary caregivers of children with congenital heart disease was recruited to participate and surveyed. Once the informed consent process had been completed, a set of paper‐based scales was used to collect data, namely socioeconomic and demographic information, the Barriers to Care for Children with Special Health Care Needs Questionnaire, and the General Health Questionnaire.Results: In total, 286 participants completed the surveys, with an average age of 34.81 years and 73.4% being female. Mean score of overall barriers was 54.45 (minimum score 39, maximum score 195, higher scores show greater perception of barriers). In Mexico, the parents/guardians of children perceived fewer barriers to access (46.69), while Peru is the country where the most barriers were perceived (69.91). Nonpoor participants showed higher overall barrier perception scores (57.34) than poor participants (52.58). The regression analysis demonstrated the overall perception of barriers was positively associated with individual and social factors, such as educational level, contract status, household monthly income, and psychological well‐being and with the country of the participants.Conclusions: Multiple factors are associated with the perception of barriers to accessing health care for children with congenital heart disease, including socioeconomic status, expectations, psychological well‐being, and structural factors.