Uncovering gaps in women's authorship: A big data analysis in academic surgery.

INTRODUCTION: Women are underrepresented in surgical authorship. Using big data analyses, we aimed to investigate women's representation as first and last authors in surgical publications worldwide and identify underlying predictors. METHODS: We retrieved eligible surgical journals using Scimago Journal & Country Rank 2021. We queried articles indexed in PubMed from selected journals published between January 2018 and April 2022. We used the EDirect tool to extract bibliometric data, including first and last authors' names, primary affiliation country, and publication year. Countries and dependent territories were classified following World Bank income levels and regions. Women's representation was predicted from forenames using the Gender-API software. Citations were included if gender accuracy was ≥80%. RESULTS: We analyzed 210,853 citations containing both first and last authors' forenames, representing 158 countries and 14 territories. Women constituted 23.8% (50,161/210,853) of the first and 14.7% (31,069/210,853) of the last authors. High-income economies had more women as first authors than other income categories (p < 0.001), but fewer women as last authors than upper-middle- and lower-middle-income economies (p < 0.001). The odds of the first author being a woman were more than three times higher when the last author was also a woman (OR 3.21, 95% CI 3.13-3.30) and vice versa (OR 3.25, 95% CI 3.16-3.34) after adjusting for income level and publication year. CONCLUSIONS: Women remain globally underrepresented in surgical authorship. Our findings urge concerted global efforts to overcome identified disparities.

Women Representation on Editorial Boards in Latin America Journals: Promoting Gender Equity in Academic Surgery, Anesthesia, and Obstetrics.

BACKGROUND: Inequitable representation in journal editorial boards may impact women's career progression across surgical, anesthesia, and obstetric (SAO) specialties. However, data from Latin America are lacking. We evaluated women's representation on editorial boards of Latin America SAO journals in 2021. METHODS: We conducted a cross-sectional analysis, retrieving journals through Scimago Journal and Country Rank 2020. Journals were included if active, focused on SAO topics, and publicly provided information on editorial board staff. Editorial board member names and positions were extracted from journals' websites. Members were classified into senior (e.g., editor-in-chief), academic (e.g., reviewer), and non-academic roles (e.g., administrative office). Women's representation was predicted from first names using Genderize.io. The number of women SAO physicians per country was obtained from articles and governmental reports. RESULTS: We included 19 of 25 identified journals and analyzed 1,318 names. Three anesthesiology, seven obstetric, and nine surgical journals represented five Latin American countries. Women held 17% (224/1,318) of board positions [p < 0.0001; 95% CI(0.14, 0.19)]. Women held fewer academic roles (14.3%, 155/1,084) compared to senior [28.9%, 64/221 (p < 0.001)] and non-academic roles [38.4%, 5/13 (p = 0.042)]. Surgical journals had fewer women (7.7%, 58/752) compared to anesthesia [25.5%, 52/204 (p = 0.006)] and obstetrics [31.5%, 114/362 (p < 0.001)]. Women's proportion on editorial boards increased according to the number of women SAO physicians per country (p < 0.001). CONCLUSIONS: Our study assessed the composition of editorial boards from Latin America SAO journals and demonstrated that women remain underrepresented. Our findings highlight the need for regional strategies to advance women's careers across SAO specialties.

Gender bias in surgery: A systematic review of qualitative studies.

BACKGROUND: In order to gain a comprehensive understanding of gender bias in the field of surgery, a systematic review was conducted to assess relevant perceptions. METHODS: We searched PubMed, Embase, and LILACS for qualitative studies on how students, trainees, and surgeons recognize gender aspects concerning surgery. Data was thematically synthesized according to Thomas and Harden's methodology. RESULTS: Eighteen articles were included, comprising 892 participants, between males and females. Twenty-four codes were generated, and two major themes were identified: gender bias and discrimination, and parenting. Bias were commonly implicit and associated with microaggressions. It involved discouragement, struggles with traditional gender norms, harassment, and lifestyle. CONCLUSIONS: We highlight the complexity of the barriers towards gender equality in surgery, addressing the lack of representativity and the persistence of bias. Understanding the obstacles and finding ways to overcome them can help to change the current situation.

Does RAS Status Increase the Prevalence of Positive Resection Margin in Colorectal Liver Metastasis? A Systematic Review and Meta-Analysis.

BACKGROUND: Colorectal liver metastasis has a high incidence, and RAS oncogene mutation status carries significant prognostic information. We aimed to assess whether RAS-mutated patients present more or less frequently with positive margins in their hepatic metastasectomy. METHODS: We performed a systematic review and meta-analysis of studies from PubMed, Embase, and Lilacs databases. We analyzed liver metastatic colorectal cancer studies, which included information on RAS status and had surgical margin analysis of the liver metastasis. Odds ratios were computed using a random-effect model due to anticipated heterogeneity. We further performed a subanalysis limited to studies that included only patients with KRAS instead of all-RAS mutations. RESULTS: From the 2,705 studies screened, 19 articles were included in the meta-analysis. There were 7,391 patients. The prevalence of positive resection margin was not significantly different between patients carrier vs non-carrier for the all-RAS mutations (OR .99; 95% CI 0.83-1.18; P = .87), and for only KRAS mutation (OR .93; 95% CI 0.73-1.19; P = .57). CONCLUSIONS: Despite the strong correlation between colorectal liver metastasis prognosis and RAS mutation status, our meta-analysis's results suggest no correlation between the RAS status and the prevalence of positive resection margins. The findings contribute to a better understanding of the RAS mutation's role in the surgical resections of colorectal liver metastasis.

Women representation in academic and leadership positions in surgery in Brazil.

We aimed to analyze the representativeness of women surgeons in academic and leadership positions in Brazil. We investigated women representativeness across surgical departments of 25 Brazilian universities (2020); across boards of 10 Brazilian surgical societies (2020), and, as speakers, in 281 surgical events (Jan-2014 to Dec-2020). From 383 individuals in university departments, 43 (11.2 %) were women (p < 0.001). Only three universities had women as department chairs. From 163 positions in surgical societies, only 14 positions (8.6 %) were held by women (p < 0.001). The underrepresentation is worse in prestigious positions (presidency and vice-presidency), in which only 1 (5 %) were women. In 281 surgical events, there were 6686 speakers, of which only 886 (13.3 %) of these were women (p < 0.001). Further studies are needed to elucidate the possible causes for the gender gap in these scenarios in Brazil, so as to implement effective strategies to improve gender representativeness in surgery in the country.

Trisomy 21 and Ebstein Anomaly: Diagnosis and Prognosis of a Rare Association.

Trisomy 21 is considered the most common chromosomal aneuploidy, and congenital heart disease (CHD) is highly prevalent and relevant to the morbidity and mortality of these patients. Ebstein anomaly (EA) is a rare CHD characterized by tricuspid valve dysplasia with inferior septal leaflet displacement. Herein, we described a patient with trisomy 21 who presented with EA and discuss the association between the two conditions based on a literature review. We conclude that the concomitant occurrence of both conditions is considered to be rare. These individuals are most frequently diagnosed during birth and childhood, and they usually have a good prognosis, as observed with our patient and is typical for EA patients in general. However, it is important to be aware that electrophysiologic anomalies may also be present.

Self-medication in older European adults: Prevalence and predictive factors.

BACKGROUND/OBJECTIVES: Self-medication, despite some benefits, carries many risks, especially when practiced by older adults who are polymedicated. Information addressing the prevalence and associated factors of self-medication in older age in a European context is scarce and sometimes contradictory. This paper aims to estimate the prevalence of self-medication among older adults across Europe and to identify its predictive factors. DESIGN: Cross-sectional study. SETTING: Micro-data from the European Health Interview Survey (2006-2009) was used. PARTICIPANTS: The sample comprised 31,672 community-dwelling individuals aged 65 and over living in private households in 14 European countries. MEASUREMENTS: The analyses explored the use, over the last two weeks, of any medicines, supplements, or vitamins that were not prescribed by a doctor. RESULTS: The mean self-medication prevalence was 26.3 %, being the highest in Poland (49.4 %) and the lowest in Spain (7.8 %). Greater odds of self-medication were found for women and for participants who were younger, divorced, or presented a higher educational degree. The presence of long-standing illness and physical pain or not using prescribed medication also significantly increased the possibility of self-medication. A wide variation in the odds of self-medication between countries was also observed (up to 8 times more for Poland, compared to Spain). CONCLUSION: Self-medication is a prevalent problem among older Europeans, and even though some think it is risk-free, dangers tend to be greater with advancing age. This study will help identify the groups most likely to have this behavior so that we can focus on targeted educative and preventive initiatives.

Report of the Phenotype of a Patient with Roberts Syndrome and a Rare ESCO2 Variant.

Roberts syndrome is a rare autosomal recessive genetic disease. In this report, we report a Brazilian patient with a rare ESCO2 variant. The patient manifested a broad range of clinical findings including the significant, bilateral shortening of the extremities. He deteriorated and passed away at 20 days of age. High-resolution GTG-banded karyotype showed lack of centromeric constriction in some chromosomes, premature centromere separation in others, and repulsion of the heterochromatin regions. Molecular analysis of the ESCO2 gene revealed a deletion of 4 bp involving exon 4 in homozygosity (NM_00107420.2:c.875_878delACAG), which causes loss of ESCO2 function. We describe the clinical presentation caused by a rare ESCO2 variant.