Scientific letter
Primary gynecological care in multicultural areas
Atención ginecológica primaria en entornos multiculturales
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In our reference area, Barcelona, 62,497 women were treated for gynecological reasons in 2015 in primary care and 18,548 women in the hospital of reference, the Hospital del Mar. Our area, Raval-Ciutat Vella, represents one of the most densely populated urban districts in Barcelona, at the same time, it concentrates one of the largest immigration populations in the city.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Female immigration to urban areas is associated with greater difficulty in their health management.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> In evaluating certain public gynecological screening programs such as cervical cancer, foreign women have higher percentages of cytologic abnormalities.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> With respect to obstetric care, immigrant women in developed countries report worse experiences in all phases of pregnancy and the postpartum period.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The gender of the gynecologist may be another reason that hinders healthcare access for certain foreign patients. Currently most studies do not report differences in terms of satisfaction or quality of care received when the professional is a male.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> For most users, a gynecologist/obstetrician's qualifications are more important than gender. On the other hand, however, some studies have clearly indicated a higher preference for women to be cared for by a female practitioner. A more personal communication or greater comfort during pelvic examination are given as reasons for this, especially in certain cultures.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">An observational, cross-sectional study of the population seen by the Gynaecology and Obstetrics service of the Raval-Drassanes PCC during a normal activity month (May 2016) was performed. All women cared for by a male professional during that time were analyzed in terms of attendance, country of origin and language used. Visits were made in the language that the patient requested, and when the patient did not understand any of the routine ones used by the professional (Castilian, Catalan, English), the help of a cultural mediator was requested for translation (usually available in our center). The Helsinki Declaration criteria were followed.</p><p id="par0025" class="elsevierStylePara elsevierViewall">A total of 326 women were initially scheduled for consultation in 95<span class="elsevierStyleHsp" style=""></span>h of healthcare. Of these, 238 were finally visited and included in the analysis, 26.99% did not turn up for the appointment. Only 2 women (0.8%) declined to be cared for by a male professional. Both from Southeast Asia, and both reported the discomfort that would result if the pelvic examination was performed by a man.</p><p id="par0030" class="elsevierStylePara elsevierViewall">There were 30 different nationalities during this period. The most frequent was the Spanish population, with 79 women (33%), 67% were foreign women. Among the latter, 27 Filipinos (11%), 19 Pakistanis (8%), 17 Bengalis (7%) and 12 Moroccans (5%) were the most frequent (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). 59% of the women communicated in Spanish, 22% in Catalan and 5% in English. The remaining 14% required a translator because the patient did not master any of the previous languages; the interpretation was done by a relative or a specific cultural mediator of the center.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Our study confirms that the female population cared for by the Gynaecology service in our Primary Care area is complex and heterogeneous. In addition to the general data, 67% of the women attended at the Raval centre (Barcelona) are immigrants and the non-attendance rate is high. The countries of origin are very diverse, with a great diversity of cultures and languages. The high density of foreign population, or the frequent health coverage overlap (public and private) of some native women, could explain these biases with respect to general female immigration. These facts represent deserve attention and improvement in public health services.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Regarding the gender of the medical professional, it is concluded that the satisfaction and acceptance after care by a male gynecologist does not represent a significant factor. Only 0.8% of women refused to be examined by a man. This is especially important in a district in which Muslim women are the majority, considering that the gender of the professional can specifically influence this cohort of women. Although the future points to a progressive higher presence of female professionals,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> male specialists are still numerous in our country.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Future prospective studies should evaluate whether a higher proportion of foreign women represents a higher percentage of diseases in our environment.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Authorship/Contributors</span><p id="par0050" class="elsevierStylePara elsevierViewall">P. Nicolau and E. del Amo participated in the design and concept of the work. P. Nicolau contributed in data collection. P. Nicolau, E. del Amo and R. Carreras reviewed the data, agreed on its conclusions and wrote the final version of the manuscript.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interests</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors do not report any conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Authorship/Contributors" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interests" ] 2 => array:2 [ "identificador" => "xack290988" "titulo" => "Acknowledgements" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Nicolau P, del Amo E, Carreras R. Atención ginecológica primaria en entornos multiculturales. Med Clin (Barc). 2017;149:37–38.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2189 "Ancho" => 3170 "Tamanyo" => 274072 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Nationalities visited at the Gynaecology service of the Raval PCC (Barcelona).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Health inequality between immigrants and natives in Spain: the loss of the healthy immigrant effect in times of economic crisis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. 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