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1.
PLoS One ; 14(11): e0225039, 2019.
Article in English | MEDLINE | ID: mdl-31751359

ABSTRACT

BACKGROUND: The survival rates from breast cancer in Africa are poor and yet the incidence rates are on the rise. In this study, we hypothesized that, in Africa, a continent with great disparities in socio-economic status, race, tumor biology, and cultural characteristics, the survival rates from breast cancer vary greatly based on region, tumor biology (hormone receptor), gender, and race. We aimed to conduct the first comprehensive systematic review and meta-analysis on region, gender, tumor-biology and race-specific 5-year breast cancer survival rates in Africa and compared them to 20-year survival trends in the United States. METHODS: We searched MEDLINE, EMBASE, and Cochrane Library to identify studies on breast cancer survival in African published before October 17, 2018. Pooled 5-year survival rates of breast cancer were estimated by random-effects models. We explored sources of heterogeneity through subgroup meta-analyses and meta-regression. Results were reported as absolute difference (AD) in percentages. We compared the survival rates of breast cancer in Africa and the United States. FINDINGS: There were 54 studies included, consisting of 18,970 breast cancer cases. There was substantial heterogeneity in the survival rates (mean 52.9%, range 7-91%, I2 = 99.1%; p for heterogeneity <0.0001). Meta-regression analyses suggested that age and gender-adjusted 5-year survival rates were lower in sub-Saharan Africa compared to north Africa (AD: -25.4%; 95% CI: -34.9 - -15.82%), and in predominantly black populations compared to predominantly non-black populations (AD: -25.9%; 95% CI: 35.40 - -16.43%). Survival rates were 10 percentage points higher in the female population compared to male, but the difference was not significant. Progesterone and estrogen receptor-positive breast cancer subtypes were positively associated with survival (r = 0.39, p = 0.08 and r = 0.24, p = 0.29 respectively), but triple-negative breast cancer was negatively associated with survival. Survival rates are increasing over time more in non-black Africans (55% in 2000 versus 65% in 2018) compared to black Africans (33% in 2000 versus 40% in 2018); but, the survival rates for Africans are still significantly lower when compared to black (76% in 2015) and white (90% in 2015) populations in the United States. CONCLUSION: Regional, sub-regional, gender, and racial disparities exist, influencing the survival rates of breast cancer in Africa. Therefore, region and race-specific public health interventions coupled with prospective genetic studies are urgently needed to improve breast cancer survival in this region.

2.
Gac Sanit ; 2019 Nov 08.
Article in Spanish | MEDLINE | ID: mdl-31708124

ABSTRACT

OBJECTIVE: To identify in the international scientific literature the obstacles and potential promoters for the advancement of women academics and researchers in biomedical sciences during their professional careers. METHOD: PubMed, Scopus, CinahlPlus, Cochrane Database of Systematic Reviews, PsycInfo and Sociological Abstracts were systematically searched for articles published in English and Spanish between January 2006 and December 2016 on the phenomenon of the glass ceiling in women academics and researchers in biomedical sciences. The screening was carried out by independent reviewers. RESULTS: A total of 2254 studies were found, of which 23 were included in the review. The obstacles identified for the promotion of women academics and/or researchers in biomedical sciences are: gender bias in the evaluation of research results, individualism and lack of collaboration, women's lack of influence, the existence of gender inequalities in access to employment. The perception of sexism and discrimination in the work environment, and the difficulties in reconciling work and family life. The promoting elements are: examples of women in leadership positions, mentoring, facilitating conciliation, transparency in recruitment, participation in decision-making, gender assessment of research, awareness of gender inequalities in institutions, promoting collaboration, and pay equity. CONCLUSIONS: By enhancing the elements favouring the promotion of academic women in biomedical sciences would help to reduce the glass ceiling in the career paths of women academics and health science researchers by increasing their participation, leadership and representation. A change of organizational and institutional values is required to achieve this.

3.
Article in English | MEDLINE | ID: mdl-31754064

ABSTRACT

BACKGROUND: Current global maternal and child health policies rarely value gender equality or women's rights and are restricted to policies addressing clinical interventions and family planning. Gender equality influences the knowledge, autonomy and utilisation of contraception and healthcare, thereby affecting maternal and child health. This systematic review aims to analyse the concurrent effect of gender equality and contraception on maternal and under-5 child mortality. METHODS: A systematic review was conducted to investigate the current evidence. Studies were eligible if three themes-namely, indicators of gender equality (such as female education, labour force participation, gender-based violence), contraception, and maternal or child mortality-were present together in a single article analysing the same sample at the same time. RESULTS: Even though extensive literature on this topic exists, only three studies managed to fit the selection criteria. Findings of two studies indicated an association between intimate partner violence (IPV) and infant mortality, and also reported that women's contraceptive use increased the risk of IPV. The third study found that the mother's secondary education attainment significantly reduced child mortality, while the mother's working status increased the odds of child mortality. The researchers of all included studies specified that contraceptive use significantly reduced the risk of child mortality. CONCLUSION: Improvement in gender equality and contraception concurrently affect the reduction in child mortality. These findings provide strong support to address the research gaps and to include a gender equality approach towards maternal and child health policies.

4.
J Am Geriatr Soc ; 67(12): 2447-2454, 2019 Dec.
Article in English | MEDLINE | ID: mdl-31573074

ABSTRACT

Supporting gender equity for women working in geriatrics is important to the growth of geriatrics across disciplines and is critical in achieving our vision for a future in which we are all able to contribute to our communities and maintain our health, safety, and independence as we age. Discrimination can have a negative impact on public health, particularly with regard to those who care for the health of older Americans and other vulnerable older people. Women working in the field of geriatrics have experienced implicit and explicit discriminatory practices that mirror available data on the entire workforce. In this position article, we outline strategic objectives and accompanying practical recommendations for how geriatrics, as a field, can work together to achieve a future in which the rights of women are guaranteed and women in geriatrics have the opportunity to achieve their full potential. This article represents the official positions of the American Geriatrics Society. J Am Geriatr Soc 67:2447-2454, 2019.

5.
BMJ Glob Health ; 4(5): e001634, 2019.
Article in English | MEDLINE | ID: mdl-31565410

ABSTRACT

Objectives: Working with men/boys, in addition to women/girls, through gender-transformative programming that challenges gender inequalities is recognised as important for improving sexual and reproductive health and rights (SRHR) for all. The aim of this paper was to generate an interactive evidence and gap map (EGM) of the total review evidence on interventions engaging men/boys across the full range of WHO SRHR outcomes and report a systematic review of the quantity, quality and effect of gender-transformative interventions with men/boys to improve SRHR for all. Methods: For this EGM and systematic review, academic and non-academic databases (CINAHL, Medline, PsycINFO, Social Science Citation Index-expanded, Cochrane Library, Campbell Collaboration, Embase, Global Health Library and Scopus) were searched using terms related to SRHR, males/masculinities, systematic reviews and trials (January 2007-July 2018) with no language restrictions for review articles of SRHR interventions engaging men/boys. Data were extracted from included reviews, and AMSTAR2 was used to assess quality. Outcomes were based on WHO reproductive health strategy. Results: From the 3658 non-duplicate records screened, the total systematic reviews of interventions engaging men/boys in SRHR was mapped through an EGM (n=462 reviews) showing that such interventions were relatively evenly spread across low-income (24.5%), middle-income (37.8%) and high-income countries (37.8%). The proportion of reviews that included gender-transformative interventions engaging men/boys was low (8.4%, 39/462), the majority was in relation to violence against women/girls (n=18/39, 46.2%) and conducted in lower and middle-income countries (n=25/39, 64%). Reviews of gender-transformative interventions were generally low/critically low quality (n=34/39, 97.1%), and findings inconclusive (n=23/39, 59%), but 38.5% (n=15/39) found positive results. Conclusion: Research and programming must be strengthened in engagement of men/boys; it should be intentional in promoting a gender-transformative approach, explicit in the intervention logic models, with more robust experimental designs and measures, and supported with qualitative evaluations.

6.
Eat Behav ; 33: 85-90, 2019 04.
Article in English | MEDLINE | ID: mdl-31030007

ABSTRACT

Sexual minority adolescents are more likely than heterosexual peers to engage in maladaptive eating behaviors such as restrictive dieting. However, prior studies relied on cross-sectional data and did not test potential mechanisms. This study examined longitudinal associations between adolescent sexual minority status and three maladaptive eating behaviors (restrictive dieting, diet pill use, and drug-related dieting) in young adulthood and tested higher perceived weight status as a mediator of observed disparities. Data were drawn from Waves 2 (11th grade in 2010/2011) to 7 (4 years post high school in 2015/2016) of the NEXT Generation Health Study, a U.S. national longitudinal cohort of adolescents (n = 1925). Logistic regression analyses revealed that, relative to heterosexual females, sexual minority females were more likely to report any restrictive dieting (extreme food intake restriction) in the past year (62.9% vs. 37.0%; Adjusted Odds Ratio = 2.26, 95% CI = 1.07, 4.76). Associations between sexual minority status and diet pills use or drug-related dieting were not found. Results from structural equation modeling indicated that higher perceived weight status was a significant mediator of the association between sexual minority status and restrictive dieting among females. These findings highlight higher perceived weight status as an important cognitive mechanism explaining why sexual minority females are at heightened risk for restrictive dieting in young adulthood. To optimally inform prevention efforts, additional research is needed to test the extent to which minority stressors may shape weight perceptions and their contribution to maladaptive and disordered eating behaviors among sexual minority adolescents.


Subject(s)
Diet, Reducing/psychology , Feeding Behavior/psychology , Feeding and Eating Disorders/psychology , Minority Groups/psychology , Sexual Behavior/psychology , Sexual and Gender Minorities/psychology , Adolescent , Adult , Cohort Studies , Female , Heterosexuality/psychology , Humans , Longitudinal Studies , Male , Overweight , Young Adult
7.
Ophthalmic Epidemiol ; 26(3): 189-199, 2019 06.
Article in English | MEDLINE | ID: mdl-30767630

ABSTRACT

PURPOSE: Women bear an inequitable burden of blinding conditions compared to men primarily because they have more limited access to eye care services. This systematic review sought evidence regarding interventions to increase gender equity in eye care. METHODS: We searched MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, and EBSCO CINAHL, and contacted experts to identify studies in low- and middle-income countries of health services interventions for age-related cataract, childhood cataract, and trachoma. Eligible studies could be clinical trials or observational studies, but had to present sufficient data for intervention effects to be estimated separately for women and men. RESULTS: We included four cluster RCTs and nine observational studies. All were judged to have serious risk of bias. Six studies examined interventions involving training rural community volunteers to identify, educate and assist individuals with unmet eye care needs. Interventions were associated with reduced gender inequities in all-cause blindness, clinic attendance, cataract surgery coverage and trachoma treatment coverage (low-to-very low quality evidence). Studies in Nepal and Tanzania examining a multicomponent intervention to improve follow-up after pediatric cataract surgery found reduced gender inequities in follow-up rates at 10 weeks (low quality evidence). CONCLUSION: Limited evidence exists to inform health service planners regarding interventions to reduce gender inequity in visual impairment and blindness. Training community volunteers to identify and counsel affected individuals, and empower them to circumvent or challenge socioeconomic barriers to accessing care holds promise. Future interventions ought to explicitly consider gender in their design and implementation, and incorporate high-quality evaluation efforts.


Subject(s)
Developing Countries , Health Equity/standards , Health Services Accessibility/standards , Ophthalmology/statistics & numerical data , Female , Humans , Male , Sex Factors
8.
Lancet ; 393(10171): 587-593, 2019 02 09.
Article in English | MEDLINE | ID: mdl-30739694

ABSTRACT

In August 2018, the president of the World Bank noted that "'Human capital'-the potential of individuals-is going to be the most important long-term investment any country can make for its people's future prosperity and quality of life". Nevertheless, leaders and practitioners in academic science and medicine continue to be unaware of and poorly educated about the nature, extent, and impact of barriers to full participation of women and minorities in science and medicine around the world. This lack of awareness and education results in failures to fully mobilise the human capital of half the population and limits global technological and medical advancements. The chronic lack of recruitment, promotion, and retention of women in science and medicine is due to systemic, structural, organisational, institutional, cultural, and societal barriers to equity and inclusion. These barriers must be identified and removed through increased awareness of the challenges combined with evidence-based, data-driven approaches leading to measurable targets and outcomes. In this Review, we discuss these issues and highlight actions that could achieve gender equality in science and medicine. We survey approaches and insights that have helped to identify and remove systemic bias and barriers in science and medicine, and propose tools that will help organisational change toward gender equality. We describe tools that include formal legislation and mandated quotas at national or large-scale levels (eg, gender parity), techniques that increase fairness (eg, gender equity) through facilitated organisational cultural change at institutional levels, and professional development of core competencies at individual levels. This Review is not intended to be an extensive analysis of all the literature currently available on achieving gender equality in academic medicine and science, but rather, a reflection on finding multifactorial solutions.


Subject(s)
Medicine , Science , Sexism/prevention & control , Women's Rights , Career Choice , Career Mobility , Female , Humans , Leadership , Organizational Innovation , Organizational Objectives
9.
J Psychiatr Res ; 111: 36-43, 2019 04.
Article in English | MEDLINE | ID: mdl-30665010

ABSTRACT

Depression is a serious mental health problem with a high prevalence among medical students. It is unclear whether a gender disparity of depression exists in this population, and whether gender inequality influences depression estimates by gender. We conducted a systematic search for published systematic reviews or meta-analyses in six databases and primary studies were obtained from those records. Studies were included if they contained original data on the prevalence of depression among male and female medical students. The Gender Inequality Index (GII) and the Human Development Index (HDI) were obtained from the United Nations Development Programme website. A random effects meta-analysis of the odds ratio for depression between females and males was conducted. Meta-regression analyses were conducted to assess the association of GII and prevalence of depression. The HDI was later incorporated in a multivariable model. We included a total of 106 studies and 84,119 students from 32 different countries. Female medical students are at higher odds of depression (OR = 1.30, 95% CI 1.17-1.44, p < 0.01). A significant correlation was found between GII and prevalence of depression for female (ß = 0.24, p = 0.02) medical students, but not for male medical students. This association remained significant after adjusting for HDI. The female gender was associated with higher prevalence of depression in this population. The gender disparity in depression may be explained by the effect of gender inequality.

10.
Arch Sex Behav ; 48(1): 89-111, 2019 01.
Article in English | MEDLINE | ID: mdl-29492768

ABSTRACT

Sexual minorities are at increased risk of suicide; however, it is unclear whether there are within-sexual minority differences in risk across specific sexual identities-notably between bisexual and lesbian/gay subgroups. We therefore conducted a systematic review and meta-analysis to quantify associations between bisexual identity and self-reported suicide ideation and attempt and the moderation of these associations by gender/sex, age, sampling strategy, and measurement of sexuality. Abstracts and full texts were independently screened by two reviewers, resulting in a total of 46 studies that met inclusion criteria and reported 12-month or lifetime prevalence estimates for suicide ideation or attempt. A consistent gradient was observed across all four outcomes, whereby bisexual respondents reported the highest proportion of suicide ideation or attempt, lesbian/gay respondents the next highest proportion, and heterosexual respondents the lowest proportion. Random-effects meta-analysis comparing bisexual individuals with lesbian/gay individuals yielded odds ratios (ORs) ranging between 1.22-1.52 across the four outcomes examined. Between-study variability in ORs was large. Thirty-one percent of heterogeneity was explained by sample type (e.g., probability vs. non-probability) and 17% by gender/sex. ORs were consistently larger for women (range: 1.48-1.95, all statistically significant at p < .05) than for men (range: 1.00-1.48, all p > .05), suggesting that gender/sex moderates the association between bisexual identity and suicide risk. Within-sexual minority differences in suicide risk may be attributed to structural and interpersonal experiences of monosexism, bisexual erasure and invisibility, or lack of bisexual-affirming social support, each of which may be experienced differently across gender/sex identities.


Subject(s)
Mental Health/trends , Sexual Behavior/psychology , Sexual and Gender Minorities/psychology , Suicidal Ideation , Adult , Female , Humans , Male , Prevalence , Young Adult
11.
Gac Sanit ; 33(2): 203-210, 2019.
Article in Spanish | MEDLINE | ID: mdl-29731296

ABSTRACT

BACKGROUND: Sex and gender differences are often overlooked in research design, study implementation and scientific reporting, as well as in general science communication. This oversight limits the generalizability of research findings and their applicability to clinical practice, in particular for women but also for men. This article describes the rationale for an international set of guidelines to encourage a more systematic approach to the reporting of sex and gender in research across disciplines. METHODS: A panel of 13 experts representing nine countries developed the guidelines through a series of teleconferences, conference presentations and a 2-day workshop. An internet survey of 716 journal editors, scientists and other members of the international publishing community was conducted as well as a literatura search on sex and gender policies in scientific publishing. RESULTS: The Sex and Gender Equity in Research (SAGER) guidelines are a comprehensive procedure for reporting of sex and gender information in study design, data analyses, results and interpretation of findings. CONCLUSIONS: The SAGER guidelines are designed primarily to guide authors in preparing their manuscripts, but they are also useful for editors, as gatekeepers of science, to integrate assessment of sex and gender into all manuscripts as an integral part of the editorial process.


Subject(s)
Biomedical Research/statistics & numerical data , Sexism/prevention & control , Female , Humans , Male , Sex Factors
12.
Health Promot Int ; 2018 Dec 07.
Article in English | MEDLINE | ID: mdl-30534989

ABSTRACT

This systematic review sought to evaluate the impact of gender equality on the health of both women and men in high-income countries. A range of health outcomes arose across the 48 studies included. Gender equality was measured in various ways, including employment characteristics, political representation, access to services, and with standard indicators (such as the Global Gender Gap Index and the Gender Empowerment Measure). The effects of gender equality varied depending on the health outcome examined, and the context in which gender equality was examined (i.e. employment or domestic domain). Overall, evidence suggests that greater gender equality has a mostly positive effect on the health of males and females. We found utility in the convergence model, which postulates that gender equality will be associated with a convergence in the health outcomes of men and women, but unless there is encouragement and support for men to assume more non-traditional roles, further health gains will be stymied.

14.
Obstet Gynecol ; 132(2): 539-540, 2018 08.
Article in English | MEDLINE | ID: mdl-30045209

ABSTRACT

The American College of Obstetricians and Gynecologists reaffirms its support of unrestricted access to legal marriage for all adults. The American College of Obstetricians and Gynecologists believes that no matter how a child comes into a family, all children and parents deserve equitable protections and access to available resources to maximize the health of that family unit. Obstetrician-gynecologists should recognize the diversity in parenting desires that exists in the lesbian, gay, bisexual, transgender, queer, intersex, asexual, and gender nonconforming communities and should take steps to ensure that clinical spaces are affirming and open to all patients, such that equitable and comprehensive, reproductive health care can meet the needs of these communities. This Committee Opinion is updated to include and capture a broader diversity of the lesbian, gay, bisexual, transgender, queer, intersex, asexual, and gender nonconforming communities, and their desires surrounding family formation, including legal recognition and benefits, and additional support of the positive effect marriage equality has on physical, mental, and financial health.


Subject(s)
Gynecology/standards , Health Services Accessibility/standards , Human Rights/standards , Marriage , Obstetrics/standards , Reproductive Health Services/standards , Sexual and Gender Minorities , Female , Gynecology/ethics , Health Services Accessibility/ethics , Health Services Accessibility/legislation & jurisprudence , Healthcare Disparities/ethics , Healthcare Disparities/legislation & jurisprudence , Healthcare Disparities/standards , Human Rights/legislation & jurisprudence , Humans , Male , Marriage/legislation & jurisprudence , Obstetrics/ethics , Parenting , Patient Advocacy , Reproductive Health Services/ethics , Reproductive Health Services/legislation & jurisprudence , Sexual and Gender Minorities/legislation & jurisprudence , United States
15.
Psychol Sci ; 29(9): 1491-1503, 2018 09.
Article in English | MEDLINE | ID: mdl-29980167

ABSTRACT

Despite global gender inequalities, findings on gender differences in subjective well-being have been inconsistent. We conducted a meta-analysis on gender differences in subjective well-being to account for the type of subjective-well-being measure, sampling variability, and levels of national gender inequality from which samples are gathered. Based on 281 effect sizes for life satisfaction ( N = 1,001,802) and 264 for job satisfaction ( N = 341,949), results showed no significant gender differences in both types of subjective well-being. Supplementary meta-analyses found significantly lower job satisfaction, but not life satisfaction, in women for studies that used both life-satisfaction and job-satisfaction measures, and studies that relied on measures that previously demonstrated measurement equivalence. Using the Gender Inequality Index, we found that greater national gender inequality significantly predicts greater gender differences in job satisfaction, but not life satisfaction. We discuss the implications of these findings and the use of subjective well-being as a measure of societal progress.


Subject(s)
Job Satisfaction , Personal Satisfaction , Sex Factors , Female , Humans , Male , Socioeconomic Factors
16.
BMC Womens Health ; 18(1): 108, 2018 06 22.
Article in English | MEDLINE | ID: mdl-29929499

ABSTRACT

BACKGROUND: Female sexual dysfunction affects 41% of reproductive-age women worldwide, making it a highly prevalent medical issue. Predictors of female sexual dysfunction are multifaceted and vary from country to country. A synthesis of potential risk factors and protective factors may aid healthcare practitioners in identifying populations at risk, in addition to revealing modifiable factors to prevent sexual dysfunction among reproductive-age women. METHODS: Observational studies which assessed the prevalence and predictors of female sexual dysfunction in reproductive-age women were systematically sought in relevant databases (2000-2014). Significant predictors were extracted from each included publication. A qualitative analysis of predictors was performed with a focus on types of sexual regimes and level of human development. RESULTS: One hundred thirty-five studies from 41 countries were included in the systematic review. The types of predictors varied according to the location of the study, the type of sexual regime and the level of gender inequality in that country/region. Consistently significant risk factors of female sexual dysfunction were: poor physical health, poor mental health, stress, abortion, genitourinary problems, female genital mutilation, relationship dissatisfaction, sexual abuse, and being religious. Consistently significant protective factors included: older age at marriage, exercising, daily affection, intimate communication, having a positive body image, and sex education. Some factors however had an unclear effect: age, education, employment, parity, being in a relationship, frequency of sexual intercourse, race, alcohol consumption, smoking and masturbation. CONCLUSIONS: The sexual and reproductive lives of women are highly impacted by female sexual dysfunction, and a number of biological, psychological and social factors play a role in the prevalence of sexual dysfunction. Healthcare professionals who work with women should be aware of the many risk factors for reproductive-age women. Future prevention strategies should aim to address modifiable factors, e.g. physical activity and access to sex education; international efforts in empowering women should continue.


Subject(s)
Sexism , Sexual Dysfunction, Physiological/epidemiology , Sexual Dysfunctions, Psychological/epidemiology , Female , Health Status Disparities , Humans , Protective Factors , Qualitative Research , Risk Factors
17.
Plast Reconstr Surg ; 141(6): 1561-1577, 2018 06.
Article in English | MEDLINE | ID: mdl-29794715

ABSTRACT

BACKGROUND: Previous research has highlighted the gender-based disparities present throughout the field of surgery. This study aims to evaluate the breadth of the issues facing women in plastic surgery, worldwide. METHODS: A systematic scoping review was undertaken from October of 2016 to January of 2017, with no restrictions on date or language. A narrative synthesis of the literature according to themed issues was developed, together with a summary of relevant numeric data. RESULTS: From the 2247 articles identified, 55 articles were included in the analysis. The majority of articles were published from the United States. Eight themes were identified, as follows: (1) workforce figures; (2) gender bias and discrimination; (3) leadership and academia; (4) mentorship and role models; (5) pregnancy, parenting, and childcare; (6) relationships, work-life balance, and professional satisfaction; (7) patient/public preference; and (8) retirement and financial planning. Despite improvement in numbers over time, women plastic surgeons continue to be underrepresented in the United States, Canada, and Europe, with prevalence ranging from 14 to 25.7 percent. Academic plastic surgeons are less frequently female than male, and women academic plastic surgeons score less favorably when outcomes of academic success are evaluated. Finally, there has been a shift away from overt discrimination toward a more ingrained, implicit bias, and most published cases of bias and discrimination are in association with pregnancy. CONCLUSIONS: The first step toward addressing the issues facing women plastic surgeons is recognition and articulation of the issues. Further research may focus on analyzing geographic variation in the issues and developing appropriate interventions.


Subject(s)
Sexism , Surgery, Plastic/statistics & numerical data , Career Choice , Female , Global Health , Health Workforce/statistics & numerical data , Humans , Interprofessional Relations , Leadership , Mentors , Patient Preference , Physician's Role , Physician-Patient Relations , Physicians, Women/statistics & numerical data , Retirement/statistics & numerical data , Sex Factors , Workplace
18.
Ann Intern Med ; 168(10): 721-723, 2018 05 15.
Article in English | MEDLINE | ID: mdl-29710100

ABSTRACT

Women comprise more than one third of the active physician workforce, an estimated 46% of all physicians-in-training, and more than half of all medical students in the United States. Although progress has been made toward gender diversity in the physician workforce, disparities in compensation exist and inequities have contributed to a disproportionately low number of female physicians achieving academic advancement and serving in leadership positions. Women in medicine face other challenges, including a lack of mentors, discrimination, gender bias, cultural environment of the workplace, imposter syndrome, and the need for better work-life integration. In this position paper, the American College of Physicians summarizes the unique challenges female physicians face over the course of their careers and provides recommendations to improve gender equity and ensure that the full potential of female physicians is realized.


Subject(s)
Career Mobility , Physicians, Women/economics , Salaries and Fringe Benefits , Sexism , Academic Success , Female , Humans , Leadership , Male , Mentors , Organizational Culture , Physicians, Women/statistics & numerical data , Students, Medical/statistics & numerical data , United States , Work-Life Balance
20.
J Int AIDS Soc ; 21 Suppl 12018 02.
Article in English | MEDLINE | ID: mdl-29485735

ABSTRACT

INTRODUCTION: Global scale up of anti-retroviral therapy (ART) has led to expansion of HIV treatment and prevention across sub-Saharan Africa. However, age and gender-specific disparities persist leading to failures in fulfillment of Sustainability Development Goals, including SDG3 (achieving healthy lives and wellbeing for all, at all ages) and SDG5 (gender equality). We assessed ART initiation and adherence, loss to follow-up, all-cause death and early death, according to SDG3 and SDG5 indicators among a cohort of HIV-infected children and adolescents enrolled in care in Dar-es-Salaam, Tanzania METHODS: SDG3 indicators included young (<5 years) and older paediatric children (5 to <10 years), early adolescent (10 to <15 years) and late adolescent (15 to <20 years) age group divisions and the SDG5 indicator was gender. Associations of age group and gender with ART initiation, loss to follow-up and all-cause death, were analysed using Cox proportional hazards regression and with adherence, using generalized estimating equations (GEE) with the Poisson distribution. Associations of age group and gender with early death were analysed, using log-Poisson regression with empirical variance. RESULTS: A total of 18,315 enrollees with at least one clinic visit were included in this cohort study. Of these 7238 (40%) were young paediatric , 4169 (23%) older paediatric, 2922 (16%) early adolescent and 3986 (22%) late adolescent patients at enrolment. Just over half of paediatric and early adolescents and around four fifths of the late adolescents were female. Young paediatric patients were at greater risk of early death, being almost twice as likely to die within 90 days. Males were at greater risk of early death once initiated on ART (HR 1.35, 95% CI 1.09, 1.66)), while females in late adolescence were at greatest risk of late death (HR 2.44 [1.60, 3.74] <0.01). Late adolescents demonstrated greater non-engagement in care (RR 1.21 (95% CI 1.16, 1.26)). Among both males and females, early paediatric and late adolescent groups experienced significantly greater loss to follow-up. CONCLUSION: These findings highlight equity concerns critical to the fulfillment of SDG3 and SDG5 within services for children and adolescents living with HIV in sub-Saharan Africa. Young paediatric and late adolescent age groups were at increased risk of late diagnosis, early death, delayed treatment initiation and loss of continuity of care. Males were more likely to die earlier. Special attention to SDG3 and SDG5 disparities for children and adolescents living with HIV will be critical for fulfillment of the 2030 SDG agenda.


Subject(s)
Continuity of Patient Care , HIV Infections/mortality , HIV Infections/psychology , Health Equity , Adolescent , Adult , Age Factors , Ambulatory Care , Anti-HIV Agents/therapeutic use , Child , Child, Preschool , Cohort Studies , Female , HIV Infections/drug therapy , Humans , Infant , Male , Medication Adherence , Sex Factors , Sustainable Development , Tanzania/epidemiology , Young Adult
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