Las personas trans e intersexuales en el deporte competitivo español: tres casos / The Transsexual and Intersex People in Spanish Competitive Sport: Three Cases

La concepción cultural del deporte como una actividad predominantemente masculina ha dificultado la participación de algunos grupos sociales como mujeres, personas trans o intersexuales. El carácter sexuado del deporte se apoya en las diferencias fisiológicas entre mujeres y hombres, y una supuesta desventaja de las mujeres. Por ello, se establecen pruebas de sexo para las mujeres y el acceso de las personas trans e intersexuales se ve obstaculizado. En este estudio reconstruimos, a partir de las normativas y el contexto socio-histórico internacional, la evolución de la participación de personas trans e intersexuales en el deporte competitivo contemporáneo. Asimismo, se profundiza en la aplicación y gestión de dichas normas en el contexto español, apoyado en tres casos de deportistas trans e intersexuales españoles. La discriminación y humillación que han sufrido estas personas obliga a mantener una visión crítica de las políticas deportivas creadas hasta la actualidad

The cultural conception of sport as a predominantly male activity has hindered the participation of some social groups such as women, transsexual or intersex people. The sexed nature of sport is based on physiological differences between women and men, and a supposed women disadvantage. Thus, sex controls are established for women and then trans and intersex people's access to sport is hampered. In this study we reconstruct, based on the regulations and the international socio-historical context, the evolution of the participation of transsexual and intersex people in contemporary competitive sport. Likewise, the application and management of these norms in the Spanish context is deepened, supported by three cases of Spanish transsexual and intersex athletes. The discrimination and humiliation suffered by these persons enforce to maintain a critical vision of the sports policies hitherto created

The COVID-19 Pandemic and Ethics in Mexico Through a Gender Lens.

In Mexico, significant ethical and social issues have been raised by the COVID-19 pandemic. Some of the most pressing issues are the extent of restrictive measures, the reciprocal duties to healthcare workers, the allocation of scarce resources, and the need for research. While policy and ethical frameworks are being developed to face these problems, the gender perspective has been largely overlooked in most of the issues at stake. Domestic violence is the most prevalent form of violence against women, which can be exacerbated during a pandemic: stress and economic uncertainty are triggers for abuse, and confinement limits access to support networks. Confinement also exacerbates the unfair distribution of unpaid labor, which is disproportionately assigned to women and girls, and highlights inequality in the overall labor market. Lack of security measures has resulted in attacks towards health workers, particularly female nurses, due to fear of contamination. Finally, resource results in lack of access to other health necessities, including sexual and reproductive health services. Research across all disciplines to face-and to learn from-this crisis should be done through a gender lens, because understanding the realities of women is essential to understand the pandemic's true effects in Mexico and the world.

Multidimensional gender discrimination in workplace and depressive symptoms.

BACKGROUND: Discrimination is associated with depressive symptoms and other negative health effects, but little is known about the mental health risks of workplace gender discrimination. We aimed to investigate the association of workplace gender discrimination and depressive symptoms among employed women in South Korea. METHODS: The 6th wave (2016) survey datasets of the Korean Longitudinal Survey of Women and Family (KLoWF) were analyzed for 2,339 respondents who are identified as wage workers. Depressive symptoms were evaluated by the short-form (10-item) Center for Epidemiological Studies-Depression scale. Association of workplace gender discrimination and depressive symptoms was assessed using multivariate logistic regression, adjusted for potential confounding variables including age, income satisfaction, education level, marital status, and currently diagnosed disease. We then measured the age effect using age stratification multivariate logistic regression model. RESULTS: Women who experienced gender discrimination at workplace had higher odds of depressive symptoms regardless of the type of the discrimination including hiring, promotion, work assignments, paid wages, and firing. These associations were consistent in younger women below 40 years of age in regard to hiring, promotion, paid wages and firing, whereas inconsistent among older women above 40 years of age. LIMITATIONS: We did not investigate the effect of workplace gender discrimination on depressive symptoms in a longitudinal manner. CONCLUSIONS: Workplace gender discrimination was found to be significantly associated with depressive symptoms after adjustment for socio-demographic factors. Further, women under 40 years of age were especially vulnerable to workplace gender discrimination.

Why Bias Matters in Medicine: Qualitative Insights from Anonymous, Online Reports.

PURPOSE: Bias has been shown to influence the experience and mental health of healthcare professional trainees and faculty in academic medicine. The authors investigated the character and impact of self-reported bias experiences sustained in the academic medical arena that were submitted anonymously online to the website SystemicDisease.com. METHOD: This qualitative study analyzed 22 narratives submitted online to SystemicDisease.com between September 2015 and March 2017. Both deductive and inductive content analysis was performed, using a combination of a priori axial and open coding. RESULTS: The most commonly reported biases occurred on the basis of race and/or gender. Multiple submitters indicated this bias had influenced or threatened their intended career trajectory. Healthcare professional trainees also expressed altruistic concerns toward other underrepresented individuals as well as toward patients from disadvantaged backgrounds. CONCLUSION: Racial and gender bias constitute a considerable barrier for trainees and professionals in academic medicine. Institutional awareness of these impacts can inform interventions designed to foster a more inclusive professional climate.

Meaningful autonomy in general surgery training: Exploring for gender bias.

BACKGROUND: Resident autonomy is essential to the development of a surgical resident. This study aims to analyze gender differences in meaningful autonomy (MA) given to general surgery trainees intraoperatively. METHODS: This is a retrospective study of general surgery residents at an academic-affiliated tertiary care facility. Attending surgeons completed post-operative evaluations based on the Zwisch model (4-point scale, ≥3 indicating MA). RESULTS: Attending faculty members (37 males, 15 females) completed evaluations of 35 residents (18 males, 17 females). A total of 3574 evaluations were analyzed (1380 female, 2194 male residents) over 28 months. Multivariate analysis revealed case complexity, post graduate year level and rater gender were significantly associated with MA. Resident gender and faculty experience did not impact MA. CONCLUSIONS: In contrast to published literature, resident gender did not influence MA. This may be encouraging to surgical programs seeking strategies to address gender bias.

Taking on the Taliban: Ethical issues at the frontline of academia.

This article reflects on the challenges of developing academic research that is undertaken to create social change. I describe the ways that my research has been generated and guided by activism. Even though the descriptor of my research interests is generally gender-based violence and mental health, my research is situated within an ongoing political discourse that fundamentally opposes and normatively challenges ideologies such as those implemented at a governmental level during the Taliban regime in Afghanistan that continue to have power over Afghan women's lives. I critique the emergence of two research projects that work with women survivors of violence and develop trauma therapeutic interventions using traditional storytelling. My positionality as a woman of Muslim origin and an academic in the U.K. resulted in inescapable juxtapositions and the necessary blurring of the boundaries between personal and professional viewpoints as well as highlighting the potency of traumatic stories in contexts of conflict, oppression, silencing and marginalization. I go on to explain why I have a moral obligation as an ethicist working in global health, with resources and expertise, to systematically develop my research questions and objectives in accordance with the end-goal of tackling and deconstructing harmful ideologies and practices towards women and girls in societies marred by the violent complexities of national and international conflicts.

The Presence of Gender Bias in Letters of Recommendations Written for Urology Residency Applicants.

OBJECTIVE: To determine whether implicit gender bias exists in the urology residency application process, we compared linguistic differences in letters of recommendation (LOR) submitted for male and female applicants. METHODS: LOR were abstracted from residency applications to a urology residency program. Linguistic Inquiry and Word Count, a validated text analysis software program, characterized the linguistic content of the letters. Analyzed letters were compared according to gender of the applicant using multivariable analysis, examining the association of applicant gender, letter writer, and letter characteristics. Multivariable analysis was also performed to determine the association of letter characteristics with matching into a urology residency. RESULTS: Of 460 letters evaluated, letters for male applicants are written in a more authentic tone compared to letters written for female applicants. Letters written for male applicants contain significantly more references to personal drive, work, and power than letters written for female applicants. Significant differences are maintained on multivariable analysis when controlling for race and Step 1 score of the applicant. Letters with references to power were significantly more likely to be associated with an applicant who matched into urology than an applicant who didn't match. CONCLUSION: Significant linguistic differences exist among LOR written for men and women applying into urology, suggesting that gender bias may permeate resident recruitment. These differences may affect the likelihood of women matching into urology.

A care ethics approach to the Gender Kidney Donation Gap.

Many studies have shown that women are more likely than men to be living kidney donors, and the discrepancy is particularly marked in heterosexual couples: wives are more likely than husbands to donate a kidney to their spouse. This 'Gender Kidney Donation Gap' can be understood in terms of Carol Gilligan's claims about gender differences in ethical decision-making style, making it appropriate to analyse responses to this imbalance using an ethic of care. This article centres the vast majority of living donors, those who donate in the context of a significant pre-existing relationship. A cost-neutral approach is unfair on donors who make society richer and healthier by helping a loved one. However, models of kidney sale fail to offer an acceptable alternative, either (a) compelling donors to sell into a pool where they do not know the recipient or (b) allowing affluent individuals unfair access to kidneys. Drawing on surrogacy law in England and Wales, a model of compensation is proposed that includes a range of non-financial benefits. This option celebrates donation and expresses gratitude to all donors while avoiding the pitfalls of the marketplace, with an emphasis on fair treatment of donors. Nevertheless, if more generous treatment led to a 10% increase in directed donation, then it would be equivalent to doubling 'altruistic' stranger donations. As long as the Gender Kidney Donation Gap persists, the best response is to minimise the discomfort and disruption caused to donors by their profound act of kindness.

Sex Bias in Interventional Clinical Trials.

INTRODUCTION: Prior studies have shown that sex bias exists with subject enrollment in clinical trials, with more men being enrolled than women. The objective of this study was to identify if sex bias continues to exist in present day clinical trials entered into ClinicalTrials.gov . We hypothesize that males and females are not equally represented in recent clinical trials. MATERIALS AND METHODS: Data were abstracted from all interventional Phase I, II, and III clinical trials with adult subjects entered into ClinicalTrials.gov from January 1, 2011 to December 31, 2013 and completed by November 30, 2015. Number and sex of subjects, funding source, allocation, end point classification, interventional model, and purpose were recorded. Studies pertaining to diseases that were sex specific were excluded. RESULTS: Of 1,668 studies included in the initial search, 167 were excluded due to sex-specific study topic. Of the remaining 1,501 studies, 177,656 (51.1%) male and 170,331 (49.0%) female subjects were included. There was a significant difference in the sex of the subjects included in Phase I (64.1% male/35.9% female), Phase II (48.4% male/51.6% female), and Phase III (51.0% male/49.1% female) clinical trials (p < 0.05). Similarly, there was a significant difference in the sex of the subjects included in industry (50.7% male/49.3% female), National Institutes of Health (NIH) (56.6% male/43.4% female), "Other US Federal" (62.5% male/37.5% female), and "Other" funded (53.4% male/46.6% female) clinical trials (p < 0.0001), as well as between randomized (50.5% male/49.6% female) and nonrandomized (54.8% male/45.2% female) clinical trials (p < 0.0001). Upon evaluating if the sex of the subjects included in the individual clinical trials was equally matched, we found that only 4.1% of clinical trials had 100% sex matching, 22.2% had 80% sex matching, and 56.5% had 50% sex matching. Using a liberal 50% sex-matching criteria, Phase III and II clinical trials matched the sex of the subjects more frequently compared to Phase I trials (60.8%, 57.8%, and 45.5%, respectively, p = 0.003). CONCLUSION: These data reveal that sex bias is present in current day clinical trials. Despite legislation requiring NIH-funded clinical trials to include women, NIH-funded trials were not better than industry-funded trials at matching the inclusion of both sexes.

Association for Academic Surgery presidential address: sticky floors and glass ceilings.

This 2017 Presidential Address for the Association for Academic Surgery was delivered on February 8, 2017. It addresses the difficult topic of gender disparities in surgery. Mixing empirical data with personal anecdotes, Dr. Caprice Greenberg provides an insightful overview of this difficult challenge facing the surgical discipline and practical advice on how we can begin to address it.

Gender equality and human rights approaches to female genital mutilation: a review of international human rights norms and standards.

Two hundred million girls and women in the world are estimated to have undergone female genital mutilation (FGM), and another 15 million girls are at risk of experiencing it by 2020 in high prevalence countries (UNICEF, 2016. Female genital mutilation/cutting: a global concern. 2016). Despite decades of concerted efforts to eradicate or abandon the practice, and the increased need for clear guidance on the treatment and care of women who have undergone FGM, present efforts have not yet been able to effectively curb the number of women and girls subjected to this practice (UNICEF. Female genital mutilation/cutting: a statistical overview and exploration of the dynamics of change. 2013), nor are they sufficient to respond to health needs of millions of women and girls living with FGM. International efforts to address FGM have thus far focused primarily on preventing the practice, with less attention to treating associated health complications, caring for survivors, and engaging health care providers as key stakeholders. Recognizing this imperative, WHO developed guidelines on management of health complications of FGM. In this paper, based on foundational research for the development of WHO's guidelines, we situate the practice of FGM as a rights violation in the context of international and national policy and efforts, and explore the role of health providers in upholding health-related human rights of women at girls who are survivors, or who are at risk. Findings are based on a literature review of relevant international human rights treaties and UN Treaty Monitoring Bodies.

Female genital alteration: a compromise solution.

Despite 30 years of advocacy, the prevalence of non-therapeutic female genital alteration (FGA) in minors is stable in many countries. Educational efforts have minimally changed the prevalence of this procedure in regions where it has been widely practiced. In order to better protect female children from the serious and long-term harms of some types of non-therapeutic FGA, we must adopt a more nuanced position that acknowledges a wide spectrum of procedures that alter female genitalia. We offer a revised categorisation for non-therapeutic FGA that groups procedures by effect and not by process. Acceptance of de minimis procedures that generally do not carry long-term medical risks is culturally sensitive, does not discriminate on the basis of gender, and does not violate human rights. More morbid procedures should not be performed. However, accepting de minimis non-therapeutic f FGA procedures enhances the effort of compassionate practitioners searching for a compromise position that respects cultural differences but protects the health of their patients.