Quality of pharmaceutical advertising and gender bias in medical journals (1998-2008): a review of the scientific literature

Objective: To review the scientific literature on pharmaceutical advertising aimed at health professionals in order to determine whether gender bias has decreased and the quality of information in pharmaceutical advertising has improved over time. Methods: We performed a content analysis of original articles dealing with medical drug promotion (1998-2008), according to quality criteria such as (a) the number, validity and accessibility of bibliographic references provided in pharmaceutical advertising and (b) the extent to which gender representations were consistent with the prevalence of the diseases. Databases: PUBMED, Medline, Scopus, Sociological Abstract, Eric and LILACS. Results: We reviewed 31 articles that analyzed advertising in medical journals from 1975-2005 and were published between 1998 and 2008. We found that the number of references used to support pharmaceutical advertising claims increased from 1975 but that 50% of these references were not valid. There was a tendency to depict men in paid productive roles, while women appeared inside the home or in non-occupational social contexts. Advertisements for psychotropic and cardiovascular drugs overrepresented women and men respectively. Conclusions: The use of bibliographic references increased between 1998 and 2008. However, representation of traditional male-female roles was similar in 1975 and 2005. Pharmaceutical advertisements may contribute to reinforcing the perception that certain diseases are associated with the most frequently portrayed sex.

Simultaneous implementation of the Bachelor, Masters and PhD degrees in nursing in the Universidad Jaume I. Castellón de la Plana, Spain

We present an experience in Nursing Education, accredited and implemented under the Spanish University System Reform in a Public University (Jaume I, Castellón) which had no previous nursing studies. The academics offered included all three educational levels (Bachelor, Master's and Doctorate), with an integrated theoretical-practical-clinical teaching methodology for the Bachelor Degree, competence acquisition in research in the Master's degree, and a doctorate formed by lines of research in the field of Nursing. Studies are accredited by the National Agency for Quality Assessment, which were authorized by the Spanish Ministry of Education and implanted between 2009 and 2011.

Gender-sensitive reporting in medical research

Sex and gender differences influence the health and wellbeing of men and women. Although studies have drawn attention to observed differences between women and men across diseases, remarkably little research has been pursued to systematically investigate these underlying sex differences. Women continue to be underrepresented in clinical trials, and even in studies in which both men and women participate, systematic analysis of data to identify potential sex-based differences is lacking. Standards for reporting of clinical trials have been established to ensure provision of complete, transparent and critical information. An important step in addressing the gender imbalance would be inclusion of a gender perspective in the next Consolidated Standards of Reporting Trials (CONSORT) guideline revision. Uniform Requirements for Manuscripts Submitted to Biomedical Journals, as a set of well-recognized and widely used guidelines for authors and biomedical journals, should similarly emphasize the ethical obligation of authors to present data analyzed by gender as a matter of routine. Journal editors are also promoters of ethical research and adequate standards of reporting, and requirements for inclusion of gender analyses should be integrated into editorial policies as a matter of urgency.

Mapping and exploring health systems' response to intimate partner violence in Spain

Background: For a comprehensive health sector response to intimate partner violence (IPV), interventions should target individual and health facility levels, along with the broader health systems level which includes issues of governance, financing, planning, service delivery, monitoring and evaluation, and demand generation. This study aims to map and explore the integration of IPV response in the Spanish national health system. Methods: Information was collected on five key areas based on WHO recommendations: policy environment, protocols, training, monitoring and prevention. A systematic review of public documents was conducted to assess 39 indicators in each of Spain’s 17 regional health systems. In addition, we performed qualitative content analysis of 26 individual interviews with key informants responsible for coordinating the health sector response to IPV in Spain. Results: In 88% of the 17 autonomous regions, the laws concerning IPV included the health sector response, but the integration of IPV in regional health plans was just 41%. Despite the existence of a supportive national structure, responding to IPV still relies strongly on the will of health professionals. All seventeen regions had published comprehensive protocols to guide the health sector response to IPV, but participants recognized that responding to IPV was more complex than merely following the steps of a protocol. Published training plans existed in 43% of the regional health systems, but none had institutionalized IPV training in medical and nursing schools. Only 12% of regional health systems collected information on the quality of the IPV response, and there are many limitations to collecting information on IPV within health services, for example underreporting, fears about confidentiality, and underuse of data for monitoring purposes. Finally, preventive activities that were considered essential were not institutionalized anywhere. Conclusions: Within the Spanish health system, differences exist in terms of achievements both between regions and between the areas assessed. Progress towards integration of IPV has been notable at the level of policy, less outstanding regarding health service delivery, and very limited in terms of preventive actions.

Género y profesión en la evolución histórica de la Enfermería Comunitaria en España

El ámbito comunitario y de salud pública es probablemente el contexto donde las enfermeras han logrado mayores cotas de autonomía profesional y donde su contribución ha sido valorada en mayor medida. No obstante, todavía persisten grandes obstáculos para el pleno desarrollo, algunos de ellos vinculados a la variable género. Por ello, resulta relevante analizar, para el caso español, los antecedentes históricos de esta situación, en la medida que puede ayudar a entender muchos de los problemas y deficiencias que sigue mostrando la Enfermería Comunitaria en la actualidad. Las enfermeras comunitarias contribuyeron al desarrollo de la salud pública en la España contemporánea, proceso que se inició en los años 1920 y que culminó durante la Segunda República, pero el periodo franquista supuso un importante freno al proceso de profesionalización. A través del ejemplo del conflicto público entre enfermeras visitadoras y practicantes, que se gestó en la Segunda República, y se prolongó durante todo el periodo franquista, se analiza cómo el discurso de género estuvo presente, entre otros condicionantes, en la evolución de la Enfermería española y cómo ha venido contribuyendo, hasta nuestros días, en la estructuración de las competencias, y la distribución de responsabilidades y poder.

La enfermería como “recurso”: el proceso de profesionalización de la enfermería en la década del ‘70, entre las políticas de Estado y el modelo Médico- hegemónico

La investigación que nos planteamos busca dar cuenta de las transformaciones acaecidas a la práctica profesional de enfermería en el INE “Juan H Jara” en la década de los 70, los distintos cambios del Estado nacional y sus relaciones con la corporación médica. Cotejando el discurso enfermero con documentos y datos de la época, intentamos interpretar cuál fue la dinámica y estructura de los procesos de reproducción social, que tuvieron como resultante la gradual “invisibilización” de las prácticas de enfermería. La enfermería fue considerada como un “recurso” por los médicos, no muy distinto de otros insumos, que podían construir y deshacer según las necesidades coyunturales, esta instrumentalización se relaciona con las dificultades para el desarrollo de la capacidad de análisis crítico y la resistencia colectiva a los procesos alienantes dentro de la profesión.

Seeding a Profession: The Intersection of the State, International Interests, and the Early Development of Brazilian Nursing

State and international entities can have profound effects on the development of a country’s nursing profession. Through a global health governance lens, this paper explores the development of nursing in Brazil during the early twentieth century, and its intersections with national and international interests. Accordingly, we will show how state policies established an environment that fostered the institutionalization of nursing as a profession in Brazil and supported it as a means to increase the presence of females in nation building processes. The State focused on recruiting elite women for nursing, in part due to the Rockefeller Foundation’s involvement in the country. Nurses who worked for Rockefeller came from well-educated classes within US society with specific ideas about who should be a nurse and the roles of nurses in a healthcare system. These women served as the primary vehicles for interacting with Brazilian health authorities responsible for health system development. Their early efforts did not, however, ensure a system capable of producing nursing human resources at a rate that, in present day Brazil, could meet the health needs of the country. Findings from this paper offer new avenues for historians to explore the early roots of professional nursing through a global health governance lens, improve the understanding of the intersection between international politics and professionalization, and highlight how these factors may impact nursing human resources production in the long term.