Gender biases in Spanish rheumatology: Perception and facts

OBJECTIVE

To identify perceptions of gender bias in Spanish rheumatology and to quantify the involvement of both sexes in all areas of the specialty.

METHODS

A survey was sent to all members of the SER on participation and perception of biases and of their own competencies, and actual data on participation in governing bodies, congresses, committees, and Spanish rheumatology departments in the last 5 years were reviewed.

RESULTS

The survey was answered by 95 rheumatologists, 4.8% of SER members (14 men and 81 women), both groups being similar in terms of age, academic level, and position and work centre. No differences were detected in the distribution of work and non-work tasks between sexes, nor in invitations to positions of power in the last five years, nor in the perception of capacity to occupy the different positions of power, which was high for both sexes. Male respondents more frequently consider that activities such as participating in a scientific committee or giving a conference are not empowering. A third of both sexes consider that the SER should review its processes with a gender perspective but less than a third believe that this should be done by quotas. The reality of the last 5 years is that 1) there is a male to female ratio of 3:2 on SER boards of directors and in this period there has been no female president or treasurer; 2) in the scientific committees of the congresses men predominate (2:1) although slightly less in the local organizing committee; 3) there are more male speakers and moderators than women (very striking in satellite symposia, 4: 1); 4) 9 out of 10 editors-in-chief are men; 5) in academic positions there are 3 men for every 2 women, 9 to 1 in professorships or emeritus positions; although more women supervise residents; and 6) there are more women (60%) than men (40%) in Spanish rheumatology departments, although 75% of department chiefs are men.

CONCLUSION

Although not perceived by either the men or the women, there are biases in the involvement of women in important and leadership positions in the specialty.

[Gender blindness in medical textbooks: the case of leukemias]

OBJECTIVE

To analyse the existence of sex-differences in the content on leukemias in the Haematology and Internal Medicine textbooks recommended in the Medical Degrees, 2019-2020, by comparison with the sex-differences recognized in the scientific literature.

METHOD

Manifest content analysis of the content of chapters on leukemias in the books on hematology and internal medicine, clinical haematology and haematology undergraduate. Analysis categories: epidemiology, etiopathogenesis, diagnosis, treatment and prognosis of leukemias.

RESULTS

Epidemiological information from the revised books has a greater consideration of sex differences in incidence and prognosis but does not contain data on mortality and survival. Etiopathogenesis is described in all books as the same physiological process for both sexes and no differences in the presentation of symptoms are described in any book. Three books describe a unique treatment that is assumed equal for both sexes; two books mention the treatment of acute myeloid leukemia in pregnant women and one in chronic myeloid leukemia. No book mentions sex-differences in pharmacokinetics, efficacy, or treatment toxicity, although there is greater evidence on unequal behavior between the sexes.

CONCLUSIONS

The contents of sex and gender differences in the leukemia chapters analyzed are insufficient compared to the evidence in the scientific literature today. Hematology textbooks might increase their scientific quality in future editions, including knowledge of sex-gender interaction in the sections of epidemiology, etiology, pathogenesis, diagnosis, treatment, prognosis, and consequences of leukemias, which will contribute to better professional practices, more efficient and equitable.

De vuelta a la clínica. Métodos I. Diseños de investigación. Mayor calidad de información, mayor certeza a la respuesta

Research designs refer to the way information is obtained and are limited by ethical, economic and temporal viability. Research designs are standardized strategies to reduce biases, which in the architectural model of research are identified in the baseline state, the maneuver and the outcome; hence, there are no specific designs for each question. The design with the lowest probability of bias is the clinical trial, followed by cohort and case-control studies and, finally, by cross-sectional surveys. Among the main characteristics that give merit to research designs are the following: population inquiry, which refers to the situation of the population in relation to the clinical course/natural history of the disease; the maneuver, or action that is expected to modify the baseline state, which can be observational or experimental; follow-up, or documented monitoring that is given to each subject, which can be longitudinal or cross-sectional; and directionality, which can prolective or retrolective and refers to the timing of data collection for research purposes. It will always be better having a valuable question, even when answered with a design with higher risk of bias, than a question that is irrelevant or has no applicability.

Analysis of the Quality of Clinical Trials Published in Spanish-Language Dermatology Journals Between 1997 and 2012

INTRODUCTION

The value of randomized clinical trials (RCTs) undertaken to identify an association between an intervention and an outcome is determined by their quality and scientific rigor.

OBJECTIVE

To assess the methodological quality of RCTs published in Spanish-language dermatology journals.

METHODS

By way of a systematic manual search, we identified all the RCTs in journals published in Spain and Latin America between 1997 (the year in which the CONSORT statement was published) and 2012. Risk of bias was evaluated for each RCT by assessing the following domains: randomization sequence generation, allocation concealment, blinding of patients and those assessing outcomes, missing data, and patient follow-up. Source of funding and conflict of interest statements, if any, were recorded for each study.

RESULTS

The search identified 70 RCTs published in 21 journals. Most of the RCTs had a high risk of bias, primarily because of gaps in the reporting of important methodological aspects. The source of funding was reported in only 15 studies.

DISCUSSION AND CONCLUSIONS

In spite of the considerable number of Spanish and Latin American journals, few RCTs have been published in the 15 years analyzed. Most of the RCTs published had serious defects in that the authors omitted methodological information essential to any evaluation of the quality of the trial and failed to report sources of funding or possible conflicts of interest for the authors involved. Authors of experimental clinical research in dermatology published in Spain and Latin America need to substantially improve both the design of their trials and the reporting of results.

If the results of an article are noteworthy, read the entire article; do not rely on the abstract alone

Clinicians typically update their knowledge by reading articles on the Internet. Easy access to the articles' abstracts and a lack of time to access other information sources creates a risk that therapeutic or diagnostic decisions will be made after reading just the abstracts. Occasionally, however, the abstracts of articles from clinical trials that have not obtained statistically significant differences in the primary study endpoint have reported other positive results, for example, of a secondary endpoint or a subgroup analysis. The article, however, correctly reports all results, including those of the primary endpoint. In the abstract, the safety information of the experimental treatment is usually deficient. The whole article should be read if a clinical decision is to be made.

[Introduction to critical reading of articles: study design and biases]

The critical evaluation of an article enables professionals to make good use of the new information and therefore has direct repercussions for the benefit of our patients. Before undertaking a detailed critical reading of the chosen article, we need to consider whether the study used the most appropriate design for the question it aimed to answer (i.e., whether the level of evidence is adequate). To do this, we need to know how to classify studies in function of their design (descriptive or analytical; prospective or retrospective; cross-sectional or longitudinal) as well as their correlation with the levels of evidence. In critical reading it is also important to know the main systematic errors or biases that can affect a study. Biases can appear in any phase of a study; they can affect the sample, the development of the study, or the measurement of the results.