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Changes in study design, gender issues, and other characteristics of clinical research published in three major medical journals from 1971 to 1991.

OBJECTIVE: To examine trends in study design and other characteristics of original research published in JAMA, Lancet, and the New England Journal of Medicine (NEJM) between 1971 and 1991. DESIGN: A retrospective cross-sectional study of original clinical research published in JAMA, Lancet, and NEJM during 1971, 1981, and 1991. MEASUREMENTS: Four hundred forty-four articles were independently reviewed by at least two investigators and classified according to study design and other preselected study characteristics. Changes over time were analyzed by chi-square tests for categorical variables and analysis of variance for continuous variables. MAIN RESULTS: Clinical results doubled, from 17% of all articles in 1971 to 35% in 1991 (p < 0.004), while case series decreased from 30% to 4% (p < 0.0001). Of 118 clinical trials, randomized controlled trials increased from 31% to 76% (p < 0.003) and nonrandomized controlled trials decreased from 42% to 8% (p < 0.002). Multicenter studies increased from 10% to 39% (p < 0.0001) and the prevalence of health services research increased from none in 1971 to 12% in 1991 (p < 0.001). The proportion of the studies explicitly excluding women from the subject population decreased from 11% in 1971 to 3% in 1991 (p < 0.03). In 1991 7% of the studies were composed entirely of men subjects, while only 0.7% of the studies were specific to men's health. Twelve percent of the studies in 1991 were specific to women's health. Between 1971 and 1991 there was no change in the prevalence of women first authors or studies addressing women's or minorities' health issues. CONCLUSIONS: Several important changes in clinical research studies published in JAMA, Lancet, and NEJM have taken place between 1971 and 1991. Clinical trials have increased in frequency, largely replacing studies containing ten or fewer subjects. Health services research has increased in prevalence, reflecting growing interest in studies addressing the delivery of health care. Our data support the hypothesis that exclusion of women from clinical research studies is an important contributor to the paucity of data concerning women's health.

Clinical Trials as Topic↗

Gender issues.

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Animals↗

Male breast cancer: a gender issue.

The incidence of male breast cancer (MBC) is rising; however, mortality due to MBC has not changed, unlike female breast cancer. This lack of change is mostly attributable to a lack of major progress in the understanding and treatment of the disease. The treatment of MBC has been extrapolated from the knowledge of female breast cancer, despite the multiple differences in the pathogenesis, biology and genetics of these two disease entities, especially the differences with regard to the role of male hormones as well as estrogens in MBC compared with female disease. Although major advances in hormonal manipulation for the treatment of breast cancer are being developed, an improved understanding of the potential differences between male and female breast cancer is essential, as this would provide new opportunities for therapeutic intervention and probable improved outcome for MBC. This review aims at highlighting the major differences between male and female breast cancer with an emphasis on hormonal therapy, and discusses some of the recent advances in MBC.

Antineoplastic Agents, Hormonal↗

Reflections on research on reading disability with special attention to gender issues.

This commentary reviews some of the issues involved in the definition of reading disability and demonstrates how definitions can influence the conclusions reached by a review. In particular, the discrepancy definition of reading disability is shown to be logically flawed. Data from a large unbiased sample show that there are no significant differences between boys and girls in the incidence of reading difficulties.

Child↗

Gender issues in newspaper coverage of people with disabilities: a Canada-Israel comparison.

This research compared how over a three-month period Canadian and Israeli newspapers wrote about females and males with disabilities. The results showed that in both countries there was significantly greater coverage of males than females. In addition, different (and stereotypical) types of details were used to describe the two groups, and females were associated with different kinds of problems than males, including a higher incidence of violence and victimization. There were also some significant differences between the male and female journalists in this study, and evidence of sexism within the newspaper industry. This paper concludes with some ideas for altering the images of disabled women in the media.

Canada↗

Gender issues in nursing.

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Attitude of Health Personnel↗

Medical faculty's views and experiences of parental leave: a collaborative study by the Gender Issues Committee, Council of Ontario Faculties of Medicine.

OBJECTIVES: To examine medical faculty's actual and ideal parental leave arrangements with the aim of informing policy decisions. Leave lengths, effect on career, financial arrangements, and availability of temporary replacements were explored. METHODS: All medical faculty (6387) in Ontario, Canada were surveyed by mail and asked about parental leave experiences since 1990. Responses of men and women were compared as were those of leave takers and the entire group. RESULTS: Thirty-two percent (n = 996) of the 3107 respondents were women and 68% (n = 2067) were men. Ninety-eight percent (n = 317) of new mothers had taken maternity leave, while only 21% (n = 159) of new fathers had. Both paid and unpaid leave was generally shorter than that allowed by law or identified as ideal. Parental leave had a somewhat negative effect on the careers of all faculty. Women were more worried than men about the effect of their absence on colleagues' work and more generous with ideal leave length and funding. Temporary replacement of leave takers was central to an effective leave policy. CONCLUSIONS: Institutional and academic culture may cause new parents to take suboptimal leave despite legislation allowing more. A change in the work environment is required for medicine to offer its teachers what it teaches--that infants benefit from nurturing, nursing, and stability early in life.

Attitude of Health Personnel↗

Gender issue neglected aspect of health promotion in Pakistan.

OBJECTIVE: To identify neglected aspects of primary health care activities and propose effective strategies for better health promotion in Pakistan. METHOD: An observation study was carried out from March-July, 1998 in a low-medium income group in Karachi West in a primary health care set-up. RESULTS: Seventy-three percent of female clients were influenced by the advice of male members of the family, 22% followed the directions of elderly female member, 5% availed health services on their own will. CONCLUSION: The Pakistani female community is influenced strongly by the male members of the family in almost all health related activities.

Family↗

Women and men managers in pharmacy: gender issues.

This paper examines the backgrounds, behaviours, and attitudes of a representative sample of male and female pharmacy managers in Ontario, Canada. It shows that the female managers are younger than their male colleagues, and spend significantly more time on childcare activities. There were no differences between the male and female managers in terms of work commitment and job responsibilities, but the female managers spent more time in direct patient contact, an activity that the qualitative analysis indicated was important to them. Female managers were also more supportive of strategies that would encourage additional patient counseling. For faculty in health administration programs, the results suggest that the importance that females place on the psycho-social aspects of their jobs as managers needs to be recognized and supported in the development and delivery of courses of study.

Administrative Personnel↗