Discrimination based on gender identity against transgender women and travestis in Brazil: a latent class analysis and associated factors.

OBJECTIVE: To identify groups of transgender women and travestis (TGW) with specific patterns of gender-based discrimination (GBD) and analyze the factors associated with GBD. METHODS: A cross-sectional study was conducted with TGW recruited through respondent-driven sampling in five Brazilian cities (2019-2021). Latent class analysis was used to characterize GBD (low, medium, and high) using 14 observable variables. Descriptive analysis was performed, and associations between predictor variables and GBD were estimated by adjusted odds ratios (aOR) using ordinal logistic regression. RESULTS: Out of a total of 1,317 TGW, 906 (68.8%) answered questions about GBD. Most were under 34 years old, single, and had a Brown race/skin color. GBD was classified as "low," "medium," and "high," with estimates of 41.7, 44.5, and 13.8%, respectively. Variables positively associated with higher intensity of GBD included living in Manaus compared to São Paulo, being ≤34 years old compared to >34, being homeless compared to living in one's own house or rented apartment, not having legally changed one's name compared to those who had, and reporting physical or sexual violence compared to those who did not report. Variables negatively associated with higher intensity of GBD included having a Brown or Asian race/skin color compared to White and a monthly income ≥1 minimum wage compared to ³1. CONCLUSION: A high proportion of GBD was observed in Brazilian TGW, with this outcome associated with more vulnerable sociodemographic characteristics and a history of violence.

Women's participation in university management in Spain: The case of Andalusian universities.

This study addresses the presence of women in the management of Andalusian public universities, Spain. The aim of this study is to determine the representation of women in the administration and management of the administrative units of Andalusian public universities at faculty and department level, as well as to identify the distribution of university administration in terms of gender of managers in university centres according to the different macro-areas of the division of scientific knowledge. The method used was a descriptive study with quantitative and ex post facto values. A sample was selected from all public universities in the Autonomous Community of Andalusia, which represent 20% of all public universities in Spain. Information was collected from all academic units and the gender of each responsible administrator was determined. The data were deposited in a virtual repository. The results revealed that, in general, there is a disproportion in the predominance of male managers and administrators compared to the number of women involved in university management tasks in Andalusia. Imbalances in gender representation at different levels of management were observed, reflecting the inequalities reported in the literature. This study confirmed the existence of gender biases in university management, aligning with existing literature, which highlights the importance of addressing gender inequalities from a holistic perspective. The findings underline the importance of continuing to work on promoting gender equality in university management through multi-factorial approaches and concrete actions.

Are Gender Identities and Gender Ideologies Associated with the Variety and Type of Owned Sex Toys? Evidence from a Large Italian Sample of Cisgender Individuals.

Research on the use of sex toys has been primarily performed from a medical perspective, while there is still limited research from a psychosocial perspective. To bridge this gap, in this study we examined whether some psychosocial variables might be linked to sex toy ownership in a sample of 3960 Italian (cisgender men and women) sex toy buyers. More specifically, we investigated the association between gender identities and ideologies and the variety and types of sex toys owned. Based on the data, we detected two dimensions underlying the ownership of sex toys: (1) orientation to owning kinky sex toys and (2) orientation to owning clit-oriented sex toys. Results showed that benevolent sexism and gender system justification were negatively correlated with owning clit-oriented toys. Moreover, strongly gender-identified participants owned a small variety of different toys and preferred toys that were designed to stimulate the vagina or clitoris over less commonly-used toys. No significant correlation between feminist identification and sex toy type owned was found when gender identification was taken into account. These results suggest that the owning of sex toys might be associated with traditional gender ideology and the strength of gender identification.

Gender Gap in academic medicine: a narrative review and the Italian forensic context.

Background: Gender gap is a neologism that identifies the disparity between social and professional conditions experienced by females compared to males. The disparity increases as one ascends the academic hierarchy. In recent years, the debate has expanded, and more options have been planned for the elimination of the current gender gap. Methods: This research was conducted by examining the landscape of the gender gap, particularly in the academic forensic medicine field. Our analysis involved reviewing papers published between 2006 and 2024, identified through electronic database searches (PubMed). The search terms used were: "gender gap" AND "academic" AND "medicine" AND "leadership." In total, we analyzed 85 papers. Additionally, we examined data from forensic medicine residency programs. Conclusions: The representation of women in medicine is well-known. Despite the increasing number of women in leadership positions in medicine, they still lag significantly behind men. These data highlight a situation that could be seen as grounds for an accusation of "academic abuse". In the Italian forensic residency programs, less than 20% are led by women, and among these, not all hold the rank of full professor. Although a certain rebalancing is already underway, the gap is still significant. There are already regulations obliging local authorities to promote gender equality in councils, companies, and institutions under their jurisdiction. It would be desirable to consider minimum quotas for female participation in university competitions. This would be a first step toward eliminating the gender gap in academic and forensic medical fields.

Evaluating gender bias in ML-based clinical risk prediction models: A study on multiple use cases at different hospitals.

BACKGROUND: An inherent difference exists between male and female bodies, the historical under-representation of females in clinical trials widened this gap in existing healthcare data. The fairness of clinical decision-support tools is at risk when developed based on biased data. This paper aims to quantitatively assess the gender bias in risk prediction models. We aim to generalize our findings by performing this investigation on multiple use cases at different hospitals. METHODS: First, we conduct a thorough analysis of the source data to find gender-based disparities. Secondly, we assess the model performance on different gender groups at different hospitals and on different use cases. Performance evaluation is quantified using the area under the receiver-operating characteristic curve (AUROC). Lastly, we investigate the clinical implications of these biases by analyzing the underdiagnosis and overdiagnosis rate, and the decision curve analysis (DCA). We also investigate the influence of model calibration on mitigating gender-related disparities in decision-making processes. RESULTS: Our data analysis reveals notable variations in incidence rates, AUROC, and over-diagnosis rates across different genders, hospitals and clinical use cases. However, it is also observed the underdiagnosis rate is consistently higher in the female population. In general, the female population exhibits lower incidence rates and the models perform worse when applied to this group. Furthermore, the decision curve analysis demonstrates there is no statistically significant difference between the model's clinical utility across gender groups within the interested range of thresholds. CONCLUSION: The presence of gender bias within risk prediction models varies across different clinical use cases and healthcare institutions. Although inherent difference is observed between male and female populations at the data source level, this variance does not affect the parity of clinical utility. In conclusion, the evaluations conducted in this study highlight the significance of continuous monitoring of gender-based disparities in various perspectives for clinical risk prediction models.

Gendered hiring and attrition on the path to parity for academic faculty.

Despite long-running efforts to increase gender diversity among tenured and tenure-track faculty in the U.S., women remain underrepresented in most academic fields, sometimes dramatically so. Here, we quantify the relative importance of faculty hiring and faculty attrition for both past and future faculty gender diversity using comprehensive data on the training and employment of 268,769 tenured and tenure-track faculty rostered at 12,112U.S. PhD-granting departments, spanning 111 academic fields between 2011 and 2020. Over this time, we find that hiring had a far greater impact on women's representation among faculty than attrition in the majority (90.1%) of academic fields, even as academia loses a higher share of women faculty relative to men at every career stage. Finally, we model the impact of five specific policy interventions on women's representation, and project that eliminating attrition differences between women and men only leads to a marginal increase in women's overall representation-in most fields, successful interventions will need to make substantial and sustained changes to hiring in order to reach gender parity.

Gender Disparities in the Academic Performance of Neurology Residents in Portugal.

Implicit bias has been linked to gender disparities in medical careers, impacting not only access to leadership positions but also early career opportunities. We aimed to evaluate if there were differences in the assessment of Neurology residents according to gender. We collected publicly available grades and rankings of two major evaluations that residents are submitted to, one at the beginning and another at the end of the neurology residency program, the National Board Exam and neurology examination, respectively. The National Board Examination is a multiple-choice gender-blinded evaluation, while the neurology examination is an oral gender-unblinded evaluation. We found that 36.5% of women and 21.6% of men were in the first quartile of the National Board Examination ranking, which reflects a similar representation among top classifications when assessed through a gender-blinded examination. On the other hand, the percentage of men who were in the top classification of NE, a gender-unblinded evaluation, was more than twice as high compared to women (37.8% vs 18.3%, p < 0.05). The findings of the present study may imply that there could be a disparity in women's career progression among neurology residents in Portugal, although the recruitment seems balanced between genders.

Barriers for pregnancy and perceptions of gender discrimination of urologists in training in France: Results of a national survey.

INTRODUCTION: Gender discrimination seems more prevalent in surgery than other medical specialties. In addition, female urologists are more likely to have obstetric complications and to be discouraged from starting a family during training. The objective of this study was to determine the prevalence of perceived gender discrimination and barriers for pregnancy during fellowship, among French urology residents and fellows. MATERIAL AND METHODS: The French Association of Urologists in Training performed a national online survey between August and September 2022. Participants were assured that their participation was anonymous. Respondents were questioned on demographics, gender discrimination and on pregnancy barriers during fellowship. RESULTS: In total, 153 members answered the questionnaire out of the 427 members of the association (36%), among which 75 women (49%). Thirty nine percent of the female respondents found that their gender was a barrier in their career advancement, versus 1% of the male (P<0.0001). Forty female respondents (53%) perceived that female urologists earned less respect than their male counterparts versus 22% of the male (P<0.0001). Among the female respondents, 19 (25%) have felt that it would not be possible to become pregnant at the time they would have wanted it and 7 (9%) reported having already been threatened to lose a fellowship position in case of a pregnancy. CONCLUSION: This survey found a high prevalence of gender discrimination among French urologists in training, perceived in majority by women. Female urologists perceived obstacles and received threats when wanting to become pregnant during their training.

Gender income differences among general practitioners with compulsory services in early career stage in underdeveloped areas: evidence from a prospective cohort study in China.

BACKGROUND: Gender equality and the gender income gap in medicine are long-standing global problems. Although gender-related differences have been widely studied in developed countries, they remain unclear in underdeveloped regions. In 2010, China initiated a national compulsory service program (CSP) to train qualified general practitioners in rural and remote areas. This study aimed to evaluate gender income differences for early career CSP and non-CSP (NCSP) graduates in underdeveloped areas. METHODS: A cohort study was conducted with 3620 CSP and NCSP graduates from four medical universities in Central and Western China. Baseline surveys and six follow-up surveys were conducted between 2015 and 2022. Incomes, including monthly mean income and proportion of performance-based income, were measured as the key outcome variables. Multivariate linear regression models were used to identify the gender income gap. RESULTS: NCSP graduates had higher average monthly incomes than CSP graduates. In the seventh year after graduation, the average monthly income for NCSP graduates was 7859 CNY while was 5379 CNY for CSP graduates. After controlling for demographic characteristics, the gender monthly income gap for CSP graduates was expanded from the fourth year (3.0%) to the sixth year (5.9%) after graduation, and that for NCSP graduates was expanded from the fifth year (11.9%) to the seventh year (16.3%) after graduation. Regarding performance-based income, it was 58.9% for NCSP graduates and 45.8% for CSP graduates in the seventh year after graduation. After controlling for performance-based income proportion, the gender income gap was reduced from 5.9 to 4.0% in the sixth year after graduation for CSP graduates, and from 16.3 to 14.4% for NCSP graduates in the seventh year after graduation. CONCLUSION: An extensive and ever-increasing gender income gap exists among young doctors in the early stages of their careers in underdeveloped areas of China. The high proportion of performance-based income among men is one of the main explanations for the observed difference. A more explicit compensation system must be established to enhance support for female health workers.

Association Between Gender and Salary Among Pediatric Hospital Medicine Physicians.

OBJECTIVES: Gender-based disparities in salary exist in multiple fields of medicine. However, there is limited data examining gender inequities in salary in pediatric hospital medicine (PHM). Our primary objective was to assess whether gender-based salary differences exist in PHM. The secondary objective was to assess if, among women, the differences in salary varied on the basis of leadership positions or self-identified race and ethnicity. METHODS: We conducted a survey-based, cross-sectional study of pediatric hospitalists in December 2021. Our primary outcomes were base and total salary, adjusted for the reported number of average weekly work hours. We performed subanalyses by presence of a leadership position, as well as race. We used a weighted t test using inverse probability weighting to compare the outcomes between genders. RESULTS: A total of 559 eligible people responded to our survey (51.0%). After propensity score weighting, women's mean base salary was 87.7% of men's base (95% confidence interval [CI] 79.8%-96.4%, P < .01), and women's total salary was 85.6% of men's total (95% CI 73.2%-100.0%, P = .05) salary. On subgroup analysis of respondents with a leadership position, women's total salary was 80.6% of men's total salary (95% CI 68.7%-94.4%, P < .01). Although women who identified as white had base salaries that were 86.6% of white men's base salary (95% CI 78.5%-95.5%, P < .01), there was no gender-based difference noted between respondents that identified as nonwhite (88.4% [69.9%-111.7%] for base salary, 80.3% [57.2% to 112.7%]). CONCLUSIONS: Gender-based discrepancies in salary exists in PHM, which were increased among those with leadership roles. Continued work and advocacy are required to achieve salary equity within PHM.

Geographic Mapping of Gender Disparities in Authorship of Cardiovascular Literature.

BACKGROUND: Women in cardiology experience considerable gender disparities in publications, which hinders their career advancements to higher faculty and senior leadership positions. However, the extent of these disparities across different types of cardiovascular literature is not well understood. OBJECTIVES: We investigated gender differences in authorship across various cardiovascular publications over a decade and examined geographic variations in the representation of women authors. METHODS: All papers published from January 1, 2010, to December 31, 2019, in 4 major cardiovascular journals (Journal of the American College of Cardiology, European Heart Journal, Journal of the American Medical Association Cardiology, and Nature Reviews Cardiology) were reviewed. RESULTS: Of the 18,535 papers with 111,562 authors, 20.6% of the authors were women, and 47.7% of the papers had no women authors. Over 10 years, the proportion of women authors remained low (20.7% in 2010 to 21.4% in 2019), with the lowest proportion in editorial papers (14.8%) and the highest in research papers (21.8%). More women as first (34.6%) and last (47.6%) authors were affiliated with institutions in the United States compared with other countries. The proportion of women middle-order authors was higher on papers with women as first authors (29.4% vs 20.5%) or last authors (30.6% vs 21.3%), compared with papers with men as first or last authors, respectively. CONCLUSIONS: Over the past decade, the proportion of women authors across all article types in major cardiovascular journals remained low. A call to action is needed to promote women in cardiology and provide them with equitable opportunities.

Determinants of financial inclusion gaps in Pakistan and implications for achieving SDGs.

This study investigates the determinants of gender disparities in financial inclusion in Pakistan using Global Findex 2021 survey data. We aim to quantify gender gaps in financial access and use, and to analyze the socio-economic factors influencing these disparities. Grounded in Sen's capability approach and behavioral economics, we employ logistic regression to examine how gender influences the ownership and usage of financial products. Our results reveal significant gender gaps: only 13% of Pakistani women have financial accounts compared to 34% of men, with similar disparities in digital finance. Socio-economic variables like education, income, and employment are found to influence financial inclusion differently for men and women. While generally supportive of financial inclusion, these factors have a weaker effect for women, suggesting deeper societal barriers. This study adds to the global financial inclusion discourse by providing a comprehensive analysis of gender disparities in Pakistan. Our findings highlight the need for gender-sensitive policies that address these disparities to achieve Sustainable Development Goals related to gender equality and economic empowerment.

Persistent gender disparity in leading dental publications across 4 decades: an observational study.

OBJECTIVES: This observational study assessed the differences in the gender of the first and last authors in the most-cited dental articles over the last 4 decades. STUDY DESIGN AND SETTING: Articles were obtained through an electronic search of the most-cited articles in dentistry by decade (total n = 400 articles). The 100 most-cited studies in each decade (1980-1989, 1990-1999, 2000-2009, and 2010-2019), with any study design, with results in dentistry were eligible. The gender of the first and last authors was determined using the Genderize database. Comparative evaluation of gender distribution in general and across the 4 decades was performed with the Chi-square test, and the contribution of variables on the citation rate of articles was performed using linear regression. RESULTS: There were statistical differences between the gender distributions, with a predominance of men in the first (83.8%) and the last (86.8%) positions (P < .001). Over the decades, there was a tendency for an increase in the proportion of women as the last author (P = .002; Chi-square trend Test), with an increase of women from 6% to 22% across the last 4 decades. However, no statistically significant differences were observed between the genders for the first author in the last 4 decades (P = .163; Chi-square trend Test). CONCLUSION: The findings indicate that men lead a large percentage of the most-cited articles in dentistry and that this trend has not shown substantial modifications over the last years. Nonetheless, for the position of last authorship, an increase in women's representativity was observed over the last decades.

Discrimination against the female surgeon in the exercise of her profession.

OBJECTIVE: To describe the discrimination experienced by the general female surgeon. METHOD: Prospective, cross-sectional and descriptive study, with a survey of 30 questions, closed, anonymous, voluntary and confidential, distributed through a link in the WhatsApp chat in a closed group of female surgeons who are members of the Asociación Mexicana de Cirugía General. RESULTS: 146 female surgeons participated, with a response rate of 58.4%. The discrimination perceived by female surgeons in training was 86 (58.9%), and 28 (19.2%) when they are already surgeons by not allowing them to perform the same procedures as their peers. Regarding the patients, discrimination against female surgeons was 72 (49.3%). They do not call them doctors, but "ladies", in 126 (86.3%), and they are asked to perform nursing duties in 120 (82.2%). On the other hand, there is also discrimination against female surgeons by nursing staff in 87 (59.6%). CONCLUSIONS: Discrimination is common in the daily surgical practice of female surgeons in all three areas: peers, patients, and nursing staff. This is an initial work, where the quantification of discrimination in Mexico is carried out. Strategies must be implemented to avoid discrimination against female surgeons and be in an environment of equality.

OBJETIVO: Describir la discriminación que vive la cirujana general en México. MÉTODO: Estudio prospectivo, transversal y descriptivo, con una encuesta de 30 preguntas cerradas, de manera anónima, voluntaria y confidencial, distribuida a través de un enlace en el chat de WhatsApp en un grupo cerrado de cirujanas de todo el país que son miembros de la Asociación Mexicana de Cirugía General. RESULTADOS: Participaron 146 cirujanas, con un porcentaje de respuesta del 58.4%. La discriminación percibida por las cirujanas en formación fue de 86 (58.9%), frente a 28 (19.2%) cuando ya son cirujanas, al no permitirles realizar los mismos procedimientos que sus pares. La discriminación por parte de los pacientes fue de 72 (49.3%). No las llaman doctoras sino «señoritas¼ en 126 (86.3%) y les solicitan hacer funciones de enfermería en 120 (82.2%). También existe discriminación hacia las cirujanas por el personal de enfermería en 87 (59.6%). CONCLUSIONES: La discriminación hacia las cirujanas es frecuente en los tres ámbitos: pares, pacientes y personal de enfermería. Este es un trabajo inicial, donde se realiza la cuantificación de la discriminación en México. Se deberán implementar las estrategias para evitar la discriminación a las cirujanas y estar en un ambiente de igualdad.

Gender disparity between first and senior authors on liver cancer research in the top journals of Gastroenterology and Hepatology.

BACKGROUND: Gender disparity is pervasive in academic medicine. This study aimed to assess the disparity between men and women with regard to first and senior author positions in primary studies on liver cancer over the last two decades. METHODS: We conducted a review of articles published in high-impact factor journals of the field of Gastroenterology and Hepatology in 2005, 2010, 2015 and 2020. First and senior authors of all ages were considered as the study population. The authors' genders were determined using the online artificial intelligence tool genderize.io (https://genderize.io/). The disparity between men and women authors was assessed using the linear-by-linear association test. RESULTS: 665 original articles from 10 journals were reviewed. The point prevalence of first women authors was 25.0% compared with 75.0% for men. The point prevalence of senior women authors was 16.3% compared with 83.7% for men. From 2000 to 2020, the proportion of first women authors increased 14.4% to 26.8% compared with 85.6%-73.2% for men (P = 0.009), and the proportion of senior women authors increased from 7.4% to 19.5%, compared with 92.6%-80.5% for men (P = 0.035). The factor independently associated with a reduced representation of women among first authors was the region of author. The factor independently associated with a reduced representation of women among senior authors was the impact factor of journals. CONCLUSION: The findings indicated a remarkable increase in the proportion of women, both first and senior authors, over the past two decades in the field of liver cancers. However, the representation of women authors in this area is far less than that of men.

Sexual Harassment, Abuse, and Discrimination in Obstetrics and Gynecology: A Systematic Review.

Importance: Unlike other surgical specialties, obstetrics and gynecology (OB-GYN) has been predominantly female for the last decade. The association of this with gender bias and sexual harassment is not known. Objective: To systematically review the prevalence of sexual harassment, bullying, abuse, and discrimination among OB-GYN clinicians and trainees and interventions aimed at reducing harassment in OB-GYN and other surgical specialties. Evidence Review: A systematic search of PubMed, Embase, and ClinicalTrials.gov was conducted to identify studies published from inception through June 13, 2023.: For the prevalence of harassment, OB-GYN clinicians and trainees on OB-GYN rotations in all subspecialties in the US or Canada were included. Personal experiences of harassment (sexual harassment, bullying, abuse, and discrimination) by other health care personnel, event reporting, burnout and exit from medicine, fear of retaliation, and related outcomes were included. Interventions across all surgical specialties in any country to decrease incidence of harassment were also evaluated. Abstracts and potentially relevant full-text articles were double screened.: Eligible studies were extracted into standard forms. Risk of bias and certainty of evidence of included research were assessed. A meta-analysis was not performed owing to heterogeneity of outcomes. Findings: A total of 10 eligible studies among 5852 participants addressed prevalence and 12 eligible studies among 2906 participants addressed interventions. The prevalence of sexual harassment (range, 250 of 907 physicians [27.6%] to 181 of 255 female gynecologic oncologists [70.9%]), workplace discrimination (range, 142 of 249 gynecologic oncologists [57.0%] to 354 of 527 gynecologic oncologists [67.2%] among women; 138 of 358 gynecologic oncologists among males [38.5%]), and bullying (131 of 248 female gynecologic oncologists [52.8%]) was frequent among OB-GYN respondents. OB-GYN trainees commonly experienced sexual harassment (253 of 366 respondents [69.1%]), which included gender harassment, unwanted sexual attention, and sexual coercion. The proportion of OB-GYN clinicians who reported their sexual harassment to anyone ranged from 21 of 250 AAGL (formerly, the American Association of Gynecologic Laparoscopists) members (8.4%) to 32 of 256 gynecologic oncologists (12.5%) compared with 32.6% of OB-GYN trainees. Mistreatment during their OB-GYN rotation was indicated by 168 of 668 medical students surveyed (25.1%). Perpetrators of harassment included physicians (30.1%), other trainees (13.1%), and operating room staff (7.7%). Various interventions were used and studied, which were associated with improved recognition of bias and reporting (eg, implementation of a video- and discussion-based mistreatment program during a surgery clerkship was associated with a decrease in medical student mistreatment reports from 14 reports in previous year to 9 reports in the first year and 4 in the second year after implementation). However, no significant decrease in the frequency of sexual harassment was found with any intervention. Conclusions and Relevance: This study found high rates of harassment behaviors within OB-GYN. Interventions to limit these behaviors were not adequately studied, were limited mostly to medical students, and typically did not specifically address sexual or other forms of harassment.