Challenges to conquer from the gender perspective in medicine: The case of spondyloarthritis.

BACKGROUND: Diagnostic delay is well-known in spondyloarthritis and studies have demonstrated a longer deferral in women. The aim of this study was to explore whether diagnostic delay of spondyloarthritis depends on clinical manifestations expressed by patients according to sex or whether it is related to a doctor's misdiagnosis bias. METHODS: A cross-sectional study of 96 men and 54 women with spondyloarthritis was performed at Alicante University General Hospital in Spain using a semistructured interview and clinical records. Comparative sex analysis were done via Student's T and Mann-Whitney U tests for parametric and nonparametric continuous variables, chi-square and Fisher's exact tests for unpaired categorical variables, and McNemar's test for paired ones. FINDINGS: The median diagnostic delay in women 7.5 (11.5) years is higher than men 4 (11) years, with a difference close to statistical significance (p = 0.053). A total of 30.2% of men received a first correct diagnosis of spondyloarthritis versus 11.1% of women (p = 0.016), indicating that men have higher probability of not having a misdiagnosis of spondyloarthritis (odds ratio = 3.5; 1.3-9). Eleven different health services referred male patients to the rheumatology clinic but only six in the case of female. No sex differences were detected in patients' manifestations of back pain at onset. However, medical records registered differences (women 44.4%, men 82.1%; p < 0.001). There were differences between patients (women 57.7%, men 35.2%; p = 0.008) and medical records in peripheral signs/symptoms at onset (women 55.6%, men 17.9%; p < 0.001). CONCLUSION: The few differences of self-reported manifestations between both sexes with spondyloarthritis as compared with their clinical records (more axial pain in men and more peripheral pain in women) suggests that the professionals' annotations reflect what they expect according to Literature, which could explain the higher misdiagnosis and diagnostic delay in women with spondyloarthritis.

La nefrología desde una perspectiva de género / Nephrology from a gender perspective

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Understanding How the Diagnostic Delay of Spondyloarthritis Differs Between Women and Men: A Systematic Review and Metaanalysis.

OBJECTIVE: To identify empirical evidence of diagnostic delay in spondyloarthritis (SpA), determine whether sex-related differences persist, and conduct an analysis from that perspective of the possible causes, including the influence of quality research, in this group of inflammatory rheumatic diseases. METHODS: A systematic review was done of delay in diagnosis of SpA in MEDLINE and EMBASE and other sources. Study quality was determined in line with the Strengthening The Reporting of OBservational studies in Epidemiology (STROBE) statement. A metaanalysis of 13 papers reporting sex-disaggregated data was performed to evaluate sex-related differences in diagnostic delay. The global effect of diagnostic delay by sex was calculated using means difference (D) through a fixed effects model. RESULTS: The review included 23,883 patients (32.3% women) from 42 papers. No significant differences between the sexes were detected for symptoms at disease onset or during evolution. However, the mean for delay in diagnosis of SpA showed sex-related differences, being 8.8 years (7.4-10.1) for women and 6.5 (5.6-7.4) for men (p = 0.01). Only 40% of papers had high quality. A metaanalysis included 12,073 participants (31.2% women). The mean global effect was D = 0.6 years (0.31-0.89), indicating that men were diagnosed 0.6 year (7 months) before women. CONCLUSION: Delay in diagnosis of SpA persists, and is longer in women than in men. There are no significant sex-related differences in symptoms that could explain sex-related differences in diagnostic delay. Methodological and possible publication bias could result in sex-biased medical practice.

[Monitoring social determinants of health]. / La vigilancia de los determinantes sociales de la salud.

Public health surveillance is the systematic and continuous collection, analysis, dissemination and interpretation of health-related data for planning, implementation and evaluation of public health initiatives. Apart from the health system, social determinants of health include the circumstances in which people are born, grow up, live, work and age, and they go a long way to explaining health inequalities. A surveillance system of the social determinants of health requires a comprehensive and social overview of health. This paper analyses the importance of monitoring social determinants of health and health inequalities, and describes some relevant aspects concerning the implementation of surveillance during the data collection, compilation and analysis phases, as well as dissemination of information and evaluation of the surveillance system. It is important to have indicators from sources designed for this purpose, such as continuous records or periodic surveys, explicitly describing its limitations and strengths. The results should be published periodically in a communicative format that both enhances the public's ability to understand the problems that affect them, whilst at the same time empowering the population, with the ultimate goal of guiding health-related initiatives at different levels of intervention.

Inequality in analgesic prescription in Spain. A gender development issue / Desigualdad en prescripción de analgésicos en España. Una cuestión de desarrollo de género

Objectives: It is well known that sex differences in analgesic prescription are not merely the logical result of greater prevalence of pain in women, since this therapeutic variability is related to factors such as educational level or social class. This study aims to analyse the relationship between analgesic prescription and gender development in different regions of Spain. Methods: Cross-sectional study of sex-differences in analgesic prescription according to the gender development of the regions studied. Analgesic prescription, pain and demographic variables were obtained from the Spanish Health Interview Survey in 2006. Gender development was measured with the Gender Development Index (GDI). A logistic regression analysis was conducted to compare analgesic prescription by sex in regions with a GDI above or below the Spanish average. Results: Once adjusted by pain, age and social class, women were more likely to be prescribed analgesics than men, odds ratio (OR) = 1.74 (1.59-1.91), as residents in regions with a lower GDI compared with those in region with a higher GDI: ORWomen = 1.26 (1.12-1.42), ORMen = 1.30 (1.13-1.50). Women experiencing pain in regions with a lower GDI were more likely than men to be treated by a general practitioner rather than by a specialist, OR = 1.32 (1.04-1.67), irrespective of age and social class. Conclusions: Gender bias may be one of the pathways by which inequalities in analgesic treatment adversely affect women's health. Moreover, research into the adequacy of analgesic treatment and the possible medicalisation of women should consider contextual factors, such as gender development (AU)

Objetivos: Las diferencias por sexo en la prescripción de analgésicos no son simplemente el resultado lógico de una mayor prevalencia del dolor en las mujeres (ya que se relaciona con factores como la educación o la clase social). El objetivo de este estudio fue analizar la relación entre la prescripción de analgésicos y el desarrollo de género de las regiones de España. Métodos: Estudio transversal de las diferencias por sexo en la prescripción de analgésicos en función del desarrollo de género de las regiones. La prescripción de analgésicos, el dolor y las variables demográficas se obtuvieron de la Encuesta Nacional de Salud de 2006. El desarrollo de género se midió con el Índice de Desarrollo al Género (IDG). Se realizó un análisis de regresión logística para comparar la prescripción de analgésicos por sexo en las regiones con IDG mayor o menor que la media española. Resultados: Independientemente del dolor, la edad y la clase social, las mujeres tienen mayor probabilidad de prescripción de analgesia que los hombres, con una odds ratio (OR) = 1,74 (1,59-1,91), así como los residentes de las regiones con menor IDG en comparación con los de regiones con mayor IDG: ORMujeres = 1,26 (1,12-1,42), ORHombres = 1,30 (1,13-1,50). Las mujeres que padecen dolor en regiones de menor IDG tienen más probabilidades de ser tratadas por un médico y no por un especialista, con una OR = 1,32 (1,04-1,67). Conclusiones: El sesgo de género puede ser una vía por la cual las desigualdades en el tratamiento analgésico afecta negativamente a la salud de las mujeres. La investigación sobre la conveniencia de la analgesia y la medicalización de las mujeres debería incluir factores de contexto, como el desarrollo de género (AU)

Inequality in analgesic prescription in Spain. A gender development issue.

OBJECTIVES: It is well known that sex differences in analgesic prescription are not merely the logical result of greater prevalence of pain in women, since this therapeutic variability is related to factors such as educational level or social class. This study aims to analyse the relationship between analgesic prescription and gender development in different regions of Spain. METHODS: Cross-sectional study of sex-differences in analgesic prescription according to the gender development of the regions studied. Analgesic prescription, pain and demographic variables were obtained from the Spanish Health Interview Survey in 2006. Gender development was measured with the Gender Development Index (GDI). A logistic regression analysis was conducted to compare analgesic prescription by sex in regions with a GDI above or below the Spanish average. RESULTS: Once adjusted by pain, age and social class, women were more likely to be prescribed analgesics than men, odds ratio (OR) = 1.74 (1.59-1.91), as residents in regions with a lower GDI compared with those in region with a higher GDI: ORWomen = 1.26 (1.12-1.42), ORMen = 1.30 (1.13-1.50). Women experiencing pain in regions with a lower GDI were more likely than men to be treated by a general practitioner rather than by a specialist, OR = 1.32 (1.04-1.67), irrespective of age and social class. CONCLUSIONS: Gender bias may be one of the pathways by which inequalities in analgesic treatment adversely affect women's health. Moreover, research into the adequacy of analgesic treatment and the possible medicalisation of women should consider contextual factors, such as gender development.

Recomendaciones para el estudio y evaluación de las diferencias de género en los ensayos clínicos de fármacos en España / Recommendations for the study an devaluation of gender differences in clinical trial sin Spain

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[Appraisal of the Millennium Development Goals by means of a review of the scientific literature in 2008]. / Valoración de los Objetivos de Desarrollo del Milenio mediante la revisión de la literatura científica en 2008.

The Millennium Development Goals (MDGs) are now at the midterm of their target period, as 2015 is the date scheduled by the United Nations Organisation (UN) for their attainment. The purpose of this article is to review the current situation of the MDGs worldwide and to analyse the barriers which are preventing them from being attained in each of the MDG areas, as well as to assess a number of the indicators evaluated. In order to do so, a review has been made of the scientific literature published on the MDGs in the principal health sciences and social sciences databases, as well as the most significant reports on the issue drawn up by the United Nations. The scientific studies on the 8 MDGs and their 18 Targets make it possible to undertake a critical analysis of the situation in which each of these Goals are found at the present time, identifying the determinants that are preventing the attainment of the Goals and the actions considered necessary in order to achieve progress. Although there have been improvements in some of the goals on a world level, the research carried out to date reveals barriers to the attainment of the MDGs, as well as the insufficient weight of the developing countries in the economic and political decision-making processes, together with the incoherence between the economic policies and the social and health policies. Furthermore, Sub-Saharan Africa constitutes the most disadvantaged region, which means that it will not attain the majority of the MDGs. Spain and the developed countries, in addition to contributing resources, can also contribute to the MDGs by means of the identification and eradication of the barriers preventing attainment. This involves promoting international economic relations under conditions of social justice, by supporting a greater decision-making power for developing countries and denouncing actions that increase social inequalities and the impoverishment of the population.

Valoración de los objetivos de desarrolo del milenio mediante la revisión de la literatura científica en 2008 / Appraisal of the millennium development goals by means of a review of the scientific literature in 2008

Los Objetivos de Desarrollo del Milenio (ODM) se encuentran actualmente a mitad de su periodo de ejecución, siendo el año 2015 la fecha prevista por la Organización de Naciones Unidas (ONU) para su alcance. El objetivo de este artículo es revisar la situación actual en la que se encuentran los ODM a nivel mundial y analizar las barreras que estarían impidiendo su consecución para cada uno de los ámbitos de los ODM, así como valorar algunos de los indicadores evaluados. Para ello, se ha revisado la literatura científica publicada sobre los ODM en las principales bases de datos de ciencias de la salud y ciencias sociales, así como los principales informes elaborados sobre el tema por Naciones Unidas. Los estudios científicos en torno a los 8 ODM y sus 18 Metas permiten realizar un análisis crítico sobre la situación en la que se encuentra en la actualidad cada uno de ellos, identificando los determinantes que están impidiendo su consecución y las acciones que se consideran necesarias para impulsar el avance. Aunque a nivel global ha habido mejoras en algunas de las metas, la investigación realizada hasta la fecha muestra barreras a la consecución de los ODM, como el insuficiente peso de los estados de los países en desarrollo sobre las decisiones económicas y políticas, así como la incoherencia entre las políticas económicas y las políticas sociales y de salud. Por otra parte, África Subsahariana constituye la región con mayor desventaja, lo que supone que no alcanzará la mayoría de los ODM. España y los países desarrollados, además de aportar recursos, pueden contribuir a los ODM mediante la identificación y erradicación de las barreras que impiden su alcance. Esto significa promover unas relaciones económicas internacionales en condiciones de justicia social, apoyando un mayor poder de decisión para los países en desarrollo, y denunciando las actuaciones que incrementan las desigualdades sociales y el empobrecimiento de la población (AU)

The Millennium Development Goals (MDGs) are now at the midterm of their target period, as 2015 is the date scheduled by the United Nations Organisation (UN) for their attainment. The purpose of this article is to review the current situation of the MDGs worldwide and to analyse the barriers which are preventing them from being attained in each of the MDG areas, as well as to assess a number of the indicators evaluated. In order to do so, a review has been made of the scientific literature published on the MDGs in the principal health sciences and social sciences databases, as well as the most significant reports on the issue drawn up by the United Nations. The scientific studies on the 8 MDGs and their 18 Targets make it possible to undertake a critical analysis of the situation in which each of these Goals are found at the present time, identifying the determinants that are preventing the attainment of the Goals and the actions considered necessary in order to achieve progress. Although there have been improvements in some of the goals on a world level, the research carried out to date reveals barriers to the attainment of the MDGs, as well as the insufficient weight of the developing countries in the economic and political decision-making processes, together with the incoherence between the economic policies and the social and health policies. Furthermore, Sub-Saharan Africa constitutes the most disadvantaged region, which means that it will not attain the majority of the MDGs. Spain and the developed countries, in addition to contributing resources, can also contribute to the MDGs by means of the identification and eradication of the barriers preventing attainment. This involves promoting international economic relations under conditions of social justice, by supporting a greater decision-making power for developing countries and denouncing actions that increase social inequalities and the impoverishment of the population (AU)

[Who benefits from health programs aimed at the poorest? Successes and failures. 2008 SESPAS Report]. / A quién benefician los programas de salud dirigidos a los más pobres? Exitos y fracasos. Informe SESPAS 2008.

International aid health programs directed at the poorest play an undoubtedly constructive role in relieving acute human suffering. These programs may, however, be counterproductive and even harmful if they obscure the need to eliminate social inequities, which are the primary cause of health inequities. The present article reviews the effectiveness of two state programs that received support from international aid to (a) improve food security in rural households and vulnerable urban groups in Colombia (1996-2005) and (b) develop a local health system in the northern area of San Salvador, El Salvador (1992-1997). International aid supports successful healthcare programs, such as food programs, could generate dependency in its beneficiaries. Factors extrinsic to cooperation (political and economic factors of the context) may affect the programs and generate social conflicts. This is the case of the program to improve access to food by subsistence production in rural areas of Colombia, which failed to reach the small farmers and benefited agricultural export production owned by wealthier groups, or interventions designed to improve health among the poorest in El Salvador.

¿A quién benefician los programas de salud dirigidos a los más pobres? Éxitos y fracasos. Informe SESPAS 2008 / Who benefits from health programs aimed at the poorest? Successes and failures. 2008 SESPAS Report

Los programas de cooperación internacional en salud dirigidos a los más pobres tienen un indudable papel constructivo al aliviar el sufrimiento humano agudo, pero resultan contraproducentes y hasta lesivos si oscurecen la necesidad de eliminar las inequidades sociales, que son la causa primaria de las inequidades en salud. El objetivo de este artículo es revisar la efectividad de dos programas estatales que recibieron ayuda de la cooperación, el primero en mejorar la seguridad alimentaria de los hogares rurales y los grupos vulnerables urbanos en Colombia (1996-2005), y el segundo en desarrollar un sistema local de salud en la zona Norte de San Salvador, El Salvador (1992- 1997). La cooperación internacional apoya programas asistenciales exitosos, como los de complementación alimentaria, que podrían generar dependencias a los beneficiarios. Además, factores externos a la cooperación (contexto de intereses políticos- económicos) influyen en los programas que apoyan, y pueden generar conflictos sociales. Es el caso del apoyo a programas de los mas pobres para la promoción de su salud en El Salvador, o de mejora de las condiciones de acceso a los alimentos mediante la producción para el autoconsumo en zonas rurales de Colombia, pues benefician la producción agraria exportable, propiedad de los más ricos, pero no al pequeño agricultor

International aid health programs directed at the poorest play an undoubtedly constructive role in relieving acute human suffering. These programs may, however, be counterproductive and even harmful if they obscure the need to eliminate social inequities, which are the primary cause of health inequities. The present article reviews the effectiveness of two state programs that received support from international aid to (a) improve food security in rural households and vulnerable urban groups in Colombia (1996-2005) and (b) develop a local health system in the northern area of San Salvador, El Salvador (1992-1997). International aid supports successful healthcare programs, such as food programs, could generate dependency in its beneficiaries. Factors extrinsic to cooperation (political and economic factors of the context) may affect the programs and generate social conflicts. This is the case of the program to improve access to food by subsistence production in rural areas of Colombia, which failed to reach the small farmers and benefited agricultural export production owned by wealthier groups, or interventions designed to improve health among the poorest in El Salvador

¿A quién benefician los programas de salud dirigidos a los más pobres? Éxitos y fracasos. Informe SESPAS 2008 / Who benefits from health programs aimed at the poorest? Successes and failures. 2008 SESPAS Report

Los programas de cooperación internacional en salud dirigidosa los más pobres tienen un indudable papel constructivoal aliviar el sufrimiento humano agudo, pero resultan contraproducentesy hasta lesivos si oscurecen la necesidad deeliminar las inequidades sociales, que son la causa primariade las inequidades en salud.El objetivo de este artículo es revisar la efectividad de dosprogramas estatales que recibieron ayuda de la cooperación,el primero en mejorar la seguridad alimentaria de los hogaresrurales y los grupos vulnerables urbanos en Colombia(1996-2005), y el segundo en desarrollar un sistema local desalud en la zona Norte de San Salvador, El Salvador (1992-1997).La cooperación internacional apoya programas asistencialesexitosos, como los de complementación alimentaria, quepodrían generar dependencias a los beneficiarios. Además,factores externos a la cooperación (contexto de intereses políticos-económicos) influyen en los programas que apoyan, ypueden generar conflictos sociales. Es el caso del apoyo aprogramas de los mas pobres para la promoción de su saluden El Salvador, o de mejora de las condiciones de acceso alos alimentos mediante la producción para el autoconsumoen zonas rurales de Colombia, pues benefician la producciónagraria exportable, propiedad de los más ricos, pero no al pequeñoagricultor(AU)

International aid health programs directed at the poorest playan undoubtedly constructive role in relieving acute human suffering.These programs may, however, be counterproductiveand even harmful if they obscure the need to eliminate socialinequities, which are the primary cause of health inequities.The present article reviews the effectiveness of two state programsthat received support from international aid to (a) improvefood security in rural households and vulnerable urbangroups in Colombia (1996-2005) and (b) develop a local healthsystem in the northern area of San Salvador, El Salvador(1992-1997).International aid supports successful healthcare programs,such as food programs, could generate dependency in its beneficiaries.Factors extrinsic to cooperation (political and economicfactors of the context) may affect the programs and generatesocial conflicts. This is the case of the program toimprove access to food by subsistence production in rural areasof Colombia, which failed to reach the small farmers and benefitedagricultural export production owned by wealthier groups,or interventions designed to improve health among the poorestin El Salvador(AU)

El reto para la salud pública de los Objetivos de Desarrollo del Milenio: un enfoque desde la epidemiología política / The challenge to public health of the Millenium Development Goals: an approach from political epidemiology

Los Objetivos de Desarrollo del Milenio, y dentro de éstos las Metas del Milenio, constituyen un plan operativo para la consecución de logros básicos dirigidos al alcance de la salud, la erradicación de la pobreza y el cumplimiento de los derechos humanos fundamentales. Sus ámbitos de acción representan un punto de entrada histórico para una eventual política social a escala mundial, donde la intervención intersectorial es imprescindible para la eficacia de ésta. La salud pública, por su naturaleza multidisciplinar, junto a la epidemiología política, constituyen herramientas útiles para contribuir a incrementar el conocimiento científico en el ámbito de la salud con relación a los Objetivos de Desarrollo del Milenio. A pesar de la oportunidad que constituye este acuerdo internacional, se ha profundizado poco acerca de las dificultades, fundamentalmente políticas para su consecución. Por lo tanto, es necesario un cambio conceptual y metodológico basado en pasar de preguntarnos acerca de los determinantes socials de la salud a cuestionarnos acerca de los determinantes politicos de los propios determinantes sociales. Esto supondría no sólo elaborar una taxonomía de las injusticias, sino encontrar puntos de entrada efectivos en las instituciones derivadas del poder político para aminorarlas (AU)

The Millennium Development Goals, and within these the Millennium Targets, constitute a working plan that strives to achieve basic goals within the field of health, eradicate poverty, and ensure compliance with basic human rights. Its scope of action represents a historic breakthrough as a step toward a possible global social policy, in which cooperation between the different sectors is essential for its efficiency. Due to its multidisciplinary nature, public health, as well as political epidemiology, can be used to help increase scientific knowledge in the field of health with respect to the Millennium Development Goals. Despite the opportunity that this international agreement provides, insufficient in-depth study has been carried out on the potential –mainly political– difficulties that could arise during its implementation. Therefore, a conceptual and methodological change is required so that concern does not simply center on social determinants of health but instead takes into consideration the political reasons behind them. To reduce inequality, not only must injustice be classified but effective ways must also be found to encourage institutions with political power to take part in this initiative (AU)

Estudios de sesgo de sexo en cardiopatía coronaria: importancia de la metodología y de los datos clínicos detallados / Studies of gender bias in coronary heart disease: importance of methodology and detailed clinical data

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[The challenge to public health of the Millenium Development Goals: an approach from political epidemiology]. / El reto para la salud pública de los Objetivos de Desarrollo del Milenio: un enfoque desde la epidemiología política.

The Millennium Development Goals, and within these the Millennium Targets, constitute a working plan that strives to achieve basic goals within the field of health, eradicate poverty, and ensure compliance with basic human rights. Its scope of action represents a historic breakthrough as a step toward a possible global social policy, in which cooperation between the different sectors is essential for its efficiency. Due to its multidisciplinary nature, public health, as well as political epidemiology, can be used to help increase scientific knowledge in the field of health with respect to the Millennium Development Goals. Despite the opportunity that this international agreement provides, insufficient in-depth study has been carried out on the potential -mainly political- difficulties that could arise during its implementation. Therefore, a conceptual and methodological change is required so that concern does not simply center on social determinants of health but instead takes into consideration the political reasons behind them. To reduce inequality, not only must injustice be classified but effective ways must also be found to encourage institutions with political power to take part in this initiative.

[Clinical trials with rofecoxib: analysis of the information from the gender perspective]. / Ensayos clínicos con rofecoxib: análisis de la información desde la perspectiva de género.

BACKGROUND AND OBJECTIVE: There is evidence if the low rate of participation or even exclusion of women in clinical trials (CT), and that sex-differences are not considered in the design and analysis of the CT. The objectives of the study were to determine whether women are properly represented in the CT with rofecoxib and to analyze the information of CT with rofecoxib from a gender perspective. MATERIAL AND METHOD: Twenty eight rofecoxib CT in adults have been reviewed, all indexed in Medline and published between 1999-2001. The FDA Guideline for the Study and Evaluation of Gender Differences in the Clinical Evaluation Drugs was used to analyze the information. RESULTS: An 80% of the trials do not describe efficacy results by sex, and only one reports side effects by sex. A 78.3% does not report stratified analysis by sex. In the discussion the possible difference by sex of the results is mentioned in 3 occasions. Only 8% of the CT considers the influence of hormonal variation in the results. The pharmacokinetics issues related specifically to women are poorly followed: in 60% of the CT it is not specified the influence of oral contraceptives in the results of the trial, and in 88.9% of CT it is not specified the influence of estrogen treatment in the results of the trial. Pregnancy as exclusion criteria is only considered in 50% of the trials. CONCLUSIONS: CT with rofecoxib has included more women than men. Important information on specific situation related to gender, recommends by FDA Guideline for the Study and Evaluation of Gender Differences in the Clinical Evaluation Drugs, have not been followed.

Ensayos clínicos con rofecoxib: análisis de la información desde la perspectiva de género / Clinical trials with rofecoxib: analysis of the information from the gender perspective

FUNDAMENTO Y OBJETIVO: Existe evidencia de la baja participación o incluso exclusión de las mujeres en los ensayos clínicos (EC) y que éstos no contemplan las diferencias según el género en su diseño y análisis. Los objetivos de este trabajo han sido determinar la representación de las mujeres en los EC con rofecoxib y analizar la información desde una perspectiva de género. MATERIAL Y MÉTODO: Se efectuó una revisión de 28 artículos sobre EC en adultos, que evaluaban el rofecoxib, indexados en Medline 1999-2001. Para el análisis de la información se siguió la Guía de la Food and Drug Administration (FDA) para el estudio y evaluación con enfoque de las diferencias entre varones y mujeres en los EC. RESULTADOS: De los 28 EC, un 80 por ciento no presentaba resultados de eficacia según el género, y sólo uno ofrecía información sobre efectos adversos por sexo. No se realizaba un análisis estratificado por este parámetro en el 78,3 por ciento de los EC, y se mencionaba este factor en el apartado 'Discusión' sólo en tres publicaciones. Sólo un 8 por ciento consideraba el impacto de las variaciones hormonales en los resultados. Se incumplían las recomendaciones con relación a la especificación del permiso de toma de anticonceptivos durante los EC (no se especificaba en el 60 por ciento de los artículos). Tampoco se especificaba cómo puede interferir en el EC el tratamiento sustitutivo de estrógenos en el 88,9 por ciento de las publicaciones. La constancia del embarazo como criterio de exclusión aparecía en un 50 por ciento de los EC. CONCLUSIONES: Los EC con rofecoxib incluyen en su conjunto a más mujeres que varones, pero incumplen las recomendaciones de la FDA sobre la conveniencia de diseñar los ensayos clínicos y analizar sus resultados con enfoque de género. (AU)