Supporting healthcare professionals from ethnic minority backgrounds to 'Step Into' a clinical academic career.

Background: There is a need to develop research focussed healthcare professionals with the clinical experience and academic skills to meet the needs of a diverse population. Yet, healthcare professionals from ethnic minority backgrounds are often faced with personal, structural or organisational barriers, which prevent them from accessing and applying for development opportunities. Aim: To undertake an evaluation of the Step into Clinical Academic Careers' programme. The programme was designed specifically for nurses, midwives and allied healthcare professionals (NMAHPs) working in NHS organisations, from ethnic minority backgrounds, who had the ambition to pursue a research or clinical academic career. Methods: Qualitative individual interviews and online evaluations were conducted to identify the views, perspectives and experiences of participants who undertook the programme. Participants were also followed up after 6 months. Results: Participants provided insights into four key areas relating to outcomes of the programme. These were (1) increased confidence, (2) increased motivation, (3) developing networks and (4) inspiring people. Conclusions: Organisations must work purposefully and collaboratively to realise equitable support for individuals from ethnic minority backgrounds, through targeted mentoring and leadership development training. Failure to do this will result in a continuation of limited diversity amongst clinical academic and clinical research leaders.

Consideration of inequalities in effectiveness trials of mHealth applications - a systematic assessment of studies from an umbrella review.

BACKGROUND: The growing use of mobile health applications (apps) for managing diabetes and hypertension entails an increased need to understand their effectiveness among different population groups. It is unclear if efficacy and effectiveness trials currently provide evidence of differential effectiveness, and if they do, a summary of such evidence is missing. Our study identified to what extent sociocultural and socioeconomic inequalities were considered in effectiveness trials of mobile health apps in diabetic and hypertensive patients and if these inequalities moderated app effectiveness. METHODS: We built on our recent umbrella review that synthesized systematic reviews (SRs) of randomized controlled trials (RCTs) on the effectiveness of health apps. Using standard SR methodologies, we identified and assessed all primary RCTs from these SRs that focused on diabetes and/or hypertension and reported on health-related outcomes and inequality-related characteristics across intervention arms. We used the PROGRESS-Plus framework to define inequality-related characteristics that affect health opportunities and outcomes. We used harvest plots to summarize the subgroups (stratified analyses or interaction terms) on moderating effects of PROGRESS-Plus. We assessed study quality using the Risk of Bias 2 tool. RESULTS: We included 72 published articles of 65 unique RCTs. Gender, age, and education were the most frequently described PROGRESS-Plus characteristics at baseline in more than half of the studies. Ethnicity and occupation followed in 21 and 15 RCTs, respectively. Seven trials investigated the moderating effect of age, gender or ethnicity on app effectiveness through subgroup analyses. Results were equivocal and covered a heterogenous set of outcomes. Results showed some concerns for a high risk of bias, mostly because participants could not be blinded to their intervention allocation. CONCLUSIONS: Besides frequently available gender, age, and education descriptives, other relevant sociocultural or socioeconomic characteristics were neither sufficiently reported nor analyzed. We encourage researchers to investigate how these characteristics moderate the effectiveness of health apps to better understand how effect heterogeneity for apps across different sociocultural or socioeconomic groups affects inequalities, to support more equitable management of non-communicable diseases in increasingly digitalized systems. REGISTRATION: https://osf.io/89dhy/ .

Tracking academic contributions to Women's empowerment in Malaysia: A bibliometric investigation.

The study implied bibliometric methods to investigate the research conducted on women's empowerment in Malaysia from 1995 to 2023. Its main objective is to explore key trends and evidence in the field of women's empowerment in Malaysia. This incorporates publication trends, identifying the most influential authors, evaluating the influential institutions, determining highly cited documents, and uncovering the most common keywords implied in the study in the field of women empowerment. Eventually, this study anticipated to provide a comprehensive idea of research encompassing women's empowerment in Malaysia within a specified period. This knowledge will be useful to foster policies and initiatives pertaining to gender equality advancement and women empowerment in Malaysia.

HIV status disclosure in the era of treat-all: the complexities of societal expectations and disclosure in marital relationships in Shinyanga, Tanzania.

Robust advancements in clinical treatment of people living with HIV (PLHIV) have resulted in the current "treatment as prevention" strategy: the inability to transmit the virus when it is undetectable. Nevertheless, disclosure within marital relationships remains important to adhere optimally to treatment and further limit transmission in the era of treat-all. Disclosure, however, can have serious social repercussions, particularly for women. This paper examines gendered disclosure decisions and their social consequences in marital relationships in Tanzania. Drawing from a 9-month ethnographic study in Shinyanga Region, we explore how Sukuma societal values shape disclosure decisions. In-depth interviews with 103 PLHIV and 19 FGDs inform our analysis. We found that societal values regarding gender and marriage significantly influence disclosure decisions in marital relationships. The HIV treat-all approach, with its focus on early treatment initiation preserved health and inability to transmit allowed men and women to carefully weigh the costs and benefits of disclosure to their marital aspirations. The benefits of antiretroviral treatment for social relations are often overlooked in medical interventions. We conclude that to reduce difficult disclosure decisions for PLHIV, emphasising community awareness of HIV treatment as prevention to mitigate the negative impacts of disclosure is needed.

The Gender-Equality Paradox in Intraindividual Academic Strengths: A Cross-Temporal Analysis.

Independent of overall achievement, girls' intraindividual academic strength is typically reading, whereas boys' strength is typically mathematics or science. Sex differences in intraindividual strengths are associated with educational and occupational sex disparities in science, technology, engineering, and mathematics (STEM) fields. Paradoxically, these sex differences are larger in more gender-equal countries, but the stability of this paradox is debated. We assessed the stability of the gender-equality paradox in intraindividual strengths, and its relation to wealth, by analyzing the academic achievement of nearly 2.5 million adolescents across 85 countries and regions in five waves (from 2006 to 2018) of the Programme for International Student Assessment (PISA). Girls' intraindividual strength in reading and boys' strength in mathematics and science were stable across countries and waves. Boys' advantage in science as an intraindividual strength was larger in more gender-equal countries, whereas girls' advantage in reading was larger in wealthier countries. The results have implications for reducing sex disparities in STEM fields.

Women's education and attitudes toward malaria in children: Evidence from Nigeria.

This study examined the effect of women's educational level on their perceptions regarding the deadliness of malaria in children. The regression results revealed that women with primary education did not differ statistically from the reference category (i.e. women with no education) in terms of their likelihood of perceiving malaria as a deadly disease in children. In contrast, women with secondary education were 4.3 percentage points more likely to perceive malaria as a deadly disease compared to the reference category. Similarly, women with higher education were 8 percentage points more likely to perceive malaria as a deadly disease compared to the reference category. These results highlight the crucial role of women's education in shaping their perceptions of disease in children, which also has implications for child health outcomes.

[Gerontological expert report on professionally justified individual services according to § 71 of the German Social Code Act (SGB) XII]. / Gerontologisches Gutachten zu fachlich begründeten Einzelleistungen nach § 71 SGB XII.

BACKGROUND: In the second half of 2023 the Senate for Science, Health and Nursing of Berlin commissioned an explicit gerontological expert report from the team of authors, which was intended to provide suggestions for the modernization and concretization of § 71 of the German Social Code Act (SGB) XII, i.e., the central social law basis for so-called care of older people. It was completed by the end of 2023. The objective of the report was to provide suggestions for a Berlin Assistance for Old People Structural Law that considers the differentiation and diversity of the life phase of old age by identifying, analyzing and describing the necessary individual services. AIM OF THE ARTICLE: The approach and the central results of the report are presented and discussed. MATERIAL AND METHODS: In a multistep procedure, combined with a multimodal research approach, various methods were combined in order to generate a comprehensive understanding of the current situation of so-called assistance for older people and gerontological justifications for its services. Critical and selective literature reviews, document analysis and qualitative guideline-based expert interviews were used. RESULTS AND DISCUSSION: The expert report contains concrete recommendations for an age phase and life situation-orientated development of individual services according to § 71 SGB XII. This relates to approaches, forms and topics of counselling that enable and support successful ageing for all older people. The report also explicitly identifies objects of necessary cash and non-cash benefits, which, even in precarious situations in old age, aim to strengthen the ability for self-help and provide the opportunity to participate independently in community life.

Proximity to cancer rehabilitation and exercise oncology by geography, race, and socioeconomic status.

BACKGROUND: Cancer rehabilitation and exercise oncology (CR/EO) have documented benefits for people living with and beyond cancer. The authors examined proximity to CR/EO programs across the United States with respect to population density, race and ethnicity, socioeconomic status, and cancer incidence and mortality rates. METHODS: This cross-sectional study was conducted in 2022-2023. Online searches were initiated to identify CR/EO programs. Geocoding was used to obtain latitudinal and longitudinal geospatial coordinates. Demographic data were abstracted from the 2020 5-year American Community Survey. Cancer incidence and mortality data were obtained from the Centers for Disease Control and Prevention. US 2013 Rural-Urban Continuum Code (RUCC) classification was used to define counties as either urban (RUCC 1-3) or rural (RUCC 4-9). Multivariable logistic regression was used to evaluate the association between being far from a program and census-tract level factors. RESULTS: In total, 2133 CR/EO programs were identified nationwide. The distance from a program increased with decreasing population density: rural tracts were 17.68 ± 0.24 miles farther from a program compared with urban tracts (p < .001). Program proximity decreased as the neighborhood deprivation index increased (p < .001). Exercise oncology programs were less common than cancer rehabilitation programs in tracts with a larger proportion of minority residents (p < .001). CONCLUSIONS: Prior research has documented that underrepresented populations have worse cancer-related symptoms and higher cancer mortality. Herein, the authors document their findings that these same populations are less likely to have proximity to CR/EO programs, which are associated with improved cancer-related symptoms and cancer mortality outcomes. To realize the positive outcomes from CR/EO programming, efforts must focus on supporting expanded programming and sustainable payment for these services.

Gender differences in adolescents' life satisfaction: A replication study in Kazakhstan.

INTRODUCTION: Whether adolescents' life satisfaction varies with gender is unclear. In a recently published study, Brisson et al. found unadjusted mean scores of life satisfaction to be higher in boys than in girls in Luxembourg, a country ranking high in gender-equality indexes. However, gender was no longer predictive of life satisfaction when well-identified predictors of life satisfaction were included in the model. The present work aimed to replicate Brisson et al.'s study in Kazakhstan, a less gender-equal country than Luxembourg, and test the gender-equality-paradox hypothesis. METHODS: We used cross-sectional data from the Health-Behavior in School-aged Children study conducted in 2022 to mirror Brisson et al.'s study design. We relied on a nationally representative sample of 7369 school attendees in Kazakhstan (MAGE = 13.4; SDAGE = 1.7; 52.3% female). We performed general linear modeling analyses to achieve our research goals. RESULTS AND CONCLUSIONS: In keeping with Brisson et al.'s study, we found unadjusted mean scores of life satisfaction to be higher in boys than in girls. The magnitude of the gender gap was lower in Kazakhstan than in Luxembourg. In contrast to Brisson et al.'s study, controlling for well-identified predictors of life satisfaction did not annul the gap in question but changed its sign. This result suggests that, ceteris paribus, girls were more satisfied with their life than boys. Overall, our replication study supports the gender-equality-paradox hypothesis. Future studies may investigate whether this paradox stems from gendered criteria of life satisfaction assessment and/or sociobiological differences in health profiles.

Negotiating what it means to be "free": gender equality and governance in North and East Syria.

In this article, I discuss the radical gender equality reforms in the Autonomous Administration of North and East Syria (AANES), also known as Rojava, and how they have affected women's lives since the implementation of the Women's Law in 2014. Based on 40 in-depth interviews, eight group interviews, and participant observation, this ethnographic study illustrates how the ideal of the "free" woman permeates society in North and East Syria, prescribing desired forms of behavior and appearance. Drawing on the literature on gender and nationalism in postcolonial processes of state building, my study provides an analysis of the AANES' gender discourse that considers the real-life governing effects of the reforms. Building from the Foucauldian premise that modern power engenders disciplinary practices, I examine how awareness-raising efforts and education seminars establish new forms of control in the public sphere. I contend that the reforms operate as governing tools and, as such, shape women's subjectivities. Engendering both discipline and resistance, they result in the emergence of new subjectivities that are not entirely determined by either ideology or by patriarchal structures.

Unravelling the nexus of microfinance and women's non-communicable disease (NCD) health outcomes in Sri Lanka: An exploratory study.

ABSTRACTNon-communicable diseases (NCDs) are a major contributor to the global burden of disease, increasingly impacting low-income and marginalised populations in low- and middle-income countries such as Sri Lanka. Microfinance could be a potential approach to target NCDs. Using an ethnographic approach with thematic analysis, this study explored the nexus between microfinance and NCD outcomes. In-depth interviews were conducted with 29 micro-loan borrowing women across 15 field sites within Puttalam district in Sri Lanka. The findings revealed that perceived increases in income from microfinance loans contributed to enhanced household health savings ability, enabling the purchase of medicines bought out-of-pocket and from privately owned pharmacies, and spending for NCD-relevant health emergencies and health-related transportation. Additionally, perceived income increases also influenced the behavioural risks, including the spending and consumption of food, and physical activity levels, both positively and negatively. The microfinance networks also influenced women's perceived social support, psychological stress and coping mechanisms, and health information transmission, positively and negatively. The findings from this study provide important insights on how financial inclusion programs such as microfinance influence the health determinants and outcomes relevant to NCDs. This can help address ways to target both NCDs and inequities of socioeconomically disadvantaged and marginalised populations, particularly women.

The prototypical UK blood donor, homophily and blood donation: Blood donors are like you, not me.

BACKGROUND AND OBJECTIVES: Homophily represents the extent to which people feel others are like them and encourages the uptake of activities they feel people like them do. Currently, there are no data on blood donor homophily with respect to (i) people's representation of the average prototypical UK blood donor and (ii) the degree of homophily with this prototype for current donors, non-donors, groups blood services wish to encourage (ethnic minorities), those who are now eligible following policy changes (e.g., men-who-have-sex-with-men: MSM) and recipients. We aim to fill these gaps in knowledge. MATERIALS AND METHODS: We surveyed the UK general population MSM, long-term blood recipients, current donors, non-donors and ethnic minorities (n = 785) to assess perceptions of the prototypical donor in terms of ethnicity, age, gender, social class, educational level and political ideology. Homophily was indexed with respect to age, gender and ethnicity. RESULTS: The prototypical UK blood donor is perceived as White, middle-aged, middle-class, college-level educated and left-wing. Current donors and MSM are more homophilous with this prototype, whereas recipients and ethnic minorities have the lowest homophily. Higher levels of homophily are associated with an increased likelihood of committing to donate. CONCLUSION: The prototype of the UK donor defined this as a White activity. This, in part, may explain why ethnic minorities are less likely to be donors. As well as traditional recruitment strategies, blood services need to consider broader structural changes such as the ethnic diversity of staff and co-designing donor spaces with local communities.

[Balancing family and career for female physicians in Germany: insights from a survey of female urologists]. / Vereinbarkeit von Familie und Beruf für Ärztinnen in Deutschland am Beispiel der Urologie.

BACKGROUND: The shortage of skilled labor in medicine is one of the most pressing challenges in healthcare. The increasing number of women in medicine, particularly in the field of urology, raises questions about the compatibility of family and career, especially concerning the work environment and working time models. OBJECTIVE: The aim of this study is to capture the impact of motherhood on the professional lives of female physicians and scientists in the field of urology in Germany. Specific challenges in this surgical specialty and the compatibility of family and career will be highlighted. METHODS: The working group "Female Physicians and Scientists in Urology" of the German Society of Urology (DGU) surveyed its 1343 female members regarding demographic data, professional status, and aspects of work-life balance. RESULTS: Among 487 female urologists in Germany, 53.4% had children. Mothers tended to be older, less frequently in training, less often in inpatient settings, and less frequently engaged in surgical activities. Notably, the proportion of full-time working mothers (36.2%) was significantly lower compared to female urologists without children (92.4%). Among female urologists with children, 32.3% reported having changed their workplace because of their children, while 10.7% indicated that their responsibilities had changed at least once after pregnancy. Additionally, 76.9% of mothers had reduced their weekly working hours due to family commitments. Multivariate analysis showed an influence of motherhood on professional status and parttime work. CONCLUSION: The fact that starting a family for women in urology in Germany is associated with a reduction in working hours and the end of clinical careers suggests a need for optimizing the compatibility of family and career in Germany. The increasing feminization of the medical profession exacerbates the existing shortage of skilled workers due to the exit of mothers from professional life. To meet the needs of working parents, particularly mothers, urgent adjustments in the work environment are necessary. Promoting flexible working time models and creating supportive conditions are crucial to preventing the loss of skilled professionals and maintaining job satisfaction in this field.

White privilege, ethnic disadvantage, and stigmatized linguistic capital: COVID-19 infection rates and lockdown law enforcement in Hong Kong.

The COVID-19 pandemic has exposed and exacerbated existing disparities in various societies. This study investigates disparities among racial, ethnic, and linguistic groups in Hong Kong's society in COVID-19 infection rates and lockdown enforcement practices that was imposed 545 times from January 2021 to September 2022 and affected 9% of the population. It is found that neighborhoods with more white individuals had lower infection rates than the overall population, while those with more ethnically minoritized groups had higher infection rates. Furthermore, hit rate tests reveal that the government targeted more neighborhoods with a higher share of individuals from linguistically minoritized groups. This novel finding suggests that not only race, but linguistic difference of the same ethnicity can cause bias. The study highlights the positive impact of providing ethnic support services on health outcomes in neighborhoods with a higher share of individuals from ethnically minoritized groups.

Can health promotion facilitate development in fragile states?: An instrumental variable estimation with panel data.

Despite the potential role of health being recognised for more than a decade in fragile contexts, there are still gaps in understanding the possible paths towards peace. Particularly, current literature on health and development presents limitations, including insufficient evidence, a lack of thorough consideration for fragility and tensions between humanitarian and developmental approaches. Building upon prior discussions and limitations, this study aims to investigate the association between health indicators and the levels of economic and human development, employing panel data of 60 fragile states covering the years 1995-2021. Seven health outcome measures and three proxy measures for economic and human developments, including GDP per capita and Human Development Index with and without inequality adjustment, are employed in instrumental variable estimation. The analysis shows a positive association between the development measures and corresponding health indicators. These results suggest that promoting the health of the people, particularly among marginalised groups such as pregnant women and children, not only has the potential to protect them but also to facilitate economic and human developments of the fragile states. There is a need for approaching with people-centred and human capability perspectives to achieve the goal of 'Health and Peace for All'.

Relationship between cognitive function and sleep quality in middle-aged and older adults for minimizing disparities and achieving equity in health: Evidence from multiple nationwide cohorts.

BACKGROUND: Cognitive decline, a heavy burden on middle-aged and older adults as global aging is aggravated, was found to be associated with sleep quality. However, the country-between heterogeneity of the association prevented us from quantifying underlying relationship and identifying potential effect modifiers for vulnerable populations and targeted interventions. METHODS: We collected data from 79,922 eligible adults in five nationwide cohorts, examined the respective relationships between cognitive function and sleep quality, synthesized underlying average relationships by meta-analysis, and explored effect modifiers by meta-regressions. Additionally, we conducted subgroup and interaction analyses to identify vulnerable populations and to determine their disparities in vulnerability. RESULTS: Although country-between disparities exist, cognitive function is robustly associated with sleep quality in middle-aged and older adults worldwide, with an effect (ß) of 0.015 [0.003, 0.027]. Executive function is the subdomain most relevant to sleep quality. Disparities in the effects of sleep quality on subdomains exist in populations with different sexes (orientation: ßfemale/ßmale = 1.615, P = 0.020), marital statuses (orientation: ßunmarried/ßmarried = 2.074, P < 0.001), education levels (orientation:ßuneducated/ßeducated = 2.074, P < 0.001) and chronic disease statuses (memory: ßunhealthy/ßhealthy = 1.560, P = 0.005). CONCLUSIONS: Cognitive function decreases with worsening sleep quality in middle-aged and older adults. Vulnerability to poor sleep generally persists in singles, females, the uneducated and people with chronic diseases. To minimize disparities and achieve health equity, we advocate for targeted interventions, i.e., encouraging socialization in singles, confirming effectiveness of hormone replacement therapy in females, employing compulsory education in middle-aged and older adults.

Twenty-Five Years of Progress-Lessons Learned From JMIR Publications to Address Gender Parity in Digital Health Authorships: Bibliometric Analysis.

BACKGROUND: Digital health research plays a vital role in advancing equitable health care. The diversity of research teams is thereby instrumental in capturing societal challenges, increasing productivity, and reducing bias in algorithms. Despite its importance, the gender distribution within digital health authorship remains largely unexplored. OBJECTIVE: This study aimed to investigate the gender distribution among first and last authors in digital health research, thereby identifying predicting factors of female authorship. METHODS: This bibliometric analysis examined the gender distribution across 59,980 publications from 1999 to 2023, spanning 42 digital health journals indexed in the Web of Science. To identify strategies ensuring equality in research, a detailed comparison of gender representation in JMIR journals was conducted within the field, as well as against a matched sample. Two-tailed Welch 2-sample t tests, Wilcoxon rank sum tests, and chi-square tests were used to assess differences. In addition, odds ratios were calculated to identify predictors of female authorship. RESULTS: The analysis revealed that 37% of first authors and 30% of last authors in digital health were female. JMIR journals demonstrated a higher representation, with 49% of first authors and 38% of last authors being female, yielding odds ratios of 1.96 (95% CI 1.90-2.03; P<.001) and 1.78 (95% CI 1.71-1.84; P<.001), respectively. Since 2008, JMIR journals have consistently featured a greater proportion of female first authors than male counterparts. Other factors that predicted female authorship included having female authors in other relevant positions and gender discordance, given the higher rate of male last authors in the field. CONCLUSIONS: There was an evident shift toward gender parity across publications in digital health, particularly from the publisher JMIR Publications. The specialized focus of its sister journals, equitable editorial policies, and transparency in the review process might contribute to these achievements. Further research is imperative to establish causality, enabling the replication of these successful strategies across other scientific fields to bridge the gender gap in digital health effectively.

Insights into retrofitting fellowships in family planning with principles of equality, race, and cultural literacy.

The Centering Equality, Race, and Cultural Literacy in Family Planning (CERCL-FP) program aims to break racial silence and dismantle structural racism in the field of family planning, by providing racial equity workshops and trainings. OBJECTIVE: The objective of this study was to begin a multi-phased, rigorous evaluation to determine the impact and outcomes of the work of CERCL-FP. STUDY DESIGN: A needs assessment with former graduates and current directors of fellowships in family planning was conducted using qualitative interviews. The focus of these interviews was to determine the ability, readiness, and willingness of the field of family planning to retrofit new curricula grounded in equity, race, and cultural literacy. RESULTS: Nine (N = 9) interviews were completed with seven board certified obstetrician-gynecologists and two board certified family medicine physicians. Three themes were identified: (1) Establishing the Distribution of Work; (2) The Push/Pull of Change from Inside and Outside: Curricula and Faculty Responsibilities; and (3) Reproductive Justice and Fellowships in Family Planning. Despite acknowledging the need to retrofit the field of family planning with content grounded in equity, race, and cultural literacy, there are structural, institutional, and individual level barriers that have limited the adoption of CERCL-FP curricula within family planning curriculum nationwide. CONCLUSION: Findings from this study illuminate multiple barriers that should be considered when expanding foundational knowledge of clinicians and researchers. IMPLICATIONS: Similar to the slow integration of research findings into clinical practice, this study shows that integration of social science and new curricula within the field of family planning faces significant barriers. Strategies to address these barriers are crucial to ensuring successful integration of equity, race, and cultural literacy within family planning.

Fostering Inclusive Curricula and Learning Environments: Inclusivity Reporting at a UK University.

Universities are under increased scrutiny with respect to creating inclusive curricula and learning environments. Students often worry about reporting a lack of inclusivity, or they simply don't know where to go to do so. The University of Manchester created a rapid inclusivity reporting form, embedded into all programme virtual learning environments to enable accessible, and if preferred anonymous, reporting of issues. The form is triaged, and an accompany communications strategy was developed to ensure the feedback loop to students was complete. The form has been a success, with many issues, particularly related to sex and gender in the curricula being improved. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-024-02049-1.