Does diversity beget diversity? A scientometric analysis of over 150,000 studies and 49,000 authors published in high-impact medical journals between 2007 and 2022.

Background: Health research that significantly impacts global clinical practice and policy is often published in high-impact factor (IF) medical journals. These outlets play a pivotal role in the worldwide dissemination of novel medical knowledge. However, researchers identifying as women and those affiliated with institutions in low- and middle-income countries (LMIC) have been largely underrepresented in high-IF journals across multiple fields of medicine. To evaluate disparities in gender and geographical representation among authors who have published in any of five top general medical journals, we conducted scientometric analyses using a large-scale dataset extracted from the New England Journal of Medicine (NEJM), Journal of the American Medical Association (JAMA), The British Medical Journal (BMJ), The Lancet, and Nature Medicine. Methods: Author metadata from all articles published in the selected journals between 2007 and 2022 were collected using the DimensionsAI platform. The Genderize.io API was then utilized to infer each author's likely gender based on their extracted first name. The World Bank country classification was used to map countries associated with researcher affiliations to the LMIC or the high-income country (HIC) category. We characterized the overall gender and country income category representation across the medical journals. In addition, we computed article-level diversity metrics and contrasted their distributions across the journals. Findings: We studied 151,536 authors across 49,764 articles published in five top medical journals, over a long period spanning 15 years. On average, approximately one-third (33.1%) of the authors of a given paper were inferred to be women; this result was consistent across the journals we studied. Further, 86.6% of the teams were exclusively composed of HIC authors; in contrast, only 3.9% were exclusively composed of LMIC authors. The probability of serving as the first or last author was significantly higher if the author was inferred to be a man (18.1% vs 16.8%, P < .01) or was affiliated with an institution in a HIC (16.9% vs 15.5%, P < .01). Our primary finding reveals that having a diverse team promotes further diversity, within the same dimension (i.e., gender or geography) and across dimensions. Notably, papers with at least one woman among the authors were more likely to also involve at least two LMIC authors (11.7% versus 10.4% in baseline, P < .001; based on inferred gender); conversely, papers with at least one LMIC author were more likely to also involve at least two women (49.4% versus 37.6%, P < .001; based on inferred gender). Conclusion: We provide a scientometric framework to assess authorship diversity. Our research suggests that the inclusiveness of high-impact medical journals is limited in terms of both gender and geography. We advocate for medical journals to adopt policies and practices that promote greater diversity and collaborative research. In addition, our findings offer a first step towards understanding the composition of teams conducting medical research globally and an opportunity for individual authors to reflect on their own collaborative research practices and possibilities to cultivate more diverse partnerships in their work.

Palliative and Supportive Care in the Philippines: Systems, Barriers, and Steps Forward.

Although integral to alleviating serious health-related suffering, global palliative care remains systemically and culturally inaccessible to many patients living in low- and middle-income countries. In the Philippines, a lower-middle income country in Southeast Asia of over 110 million people, up to 75% of patients with cancer suffer from inadequate pain relief. We reviewed factors that preclude access to basic palliative care services in the Philippines. PubMed and Google Scholar were searched thoroughly; search terms included but were not limited to "palliative care," "supportive care," "end-of-life care," and "Philippines." We found that a limited palliative care workforce, high out-of-pocket healthcare costs, and low opioid availability all hinder access to palliative care in the archipelago. Religious fatalism, strong family-orientedness, and physician reluctance to refer to palliative care providers represent contributory sociocultural factors. Efforts to improve palliative care accessibility in the country must address health systems barriers while encouraging clinicians to discuss end-of-life options in a timely manner that integrates patients' unique individual, familial, and spiritual values. Research is needed to elucidate how Filipinos-and other global populations-view end-of-life, and how palliative care strategies can be individualised accordingly.

Access to surgical treatment for hepatopancreaticobiliary cancer in the Philippines.

Hepatopancreaticobiliary cancers are among the most diagnosed cancers in the world. However, although high-income countries have the highest incidence rates, low- and middle-income countries have the highest mortality rates. In this article, we describe the geographic distribution of board-certified hepatopancreaticobiliary surgeons who provide surgical management for patients with these diseases in the Philippines. We draw attention to the geographic disparities in the distribution of these surgeons and the other factors that contribute to the lack of access. Lastly, we suggest ways forward.

Leveraging national and global political determinants of health to promote equity in cancer care.

Health and politics are deeply intertwined. In the context of national and global cancer care delivery, political forces-the political determinants of health-influence every level of the cancer care continuum. We explore the "3-I" framework, which structures the upstream political forces that affect policy choices in the context of actors' interests, ideas, and institutions, to examine how political determinants of health underlie cancer disparities. Borrowing from the work of PA Hall, M-P Pomey, CJ Ho, and other thinkers, interests are the agendas of individuals and groups in power. Ideas represent beliefs or knowledge about what is or what should be. Institutions define the rules of play. We provide examples from around the world: Political interests have helped fuel the establishment of cancer centers in India and have galvanized the 2022 Cancer Moonshot in the United States. The politics of ideas underlie global disparities in cancer clinical trials-that is, in the distribution of epistemic power. Finally, historical institutions have helped perpetuate disparities related to racist and colonialist legacies. Present institutions have also been used to improve access for those in greatest need, as exemplified by the Butaro Cancer Center of Excellence in Rwanda. In providing these global examples, we demonstrate how interests, ideas, and institutions influence access to cancer care across the breadth of the cancer continuum. We argue that these forces can be leveraged to promote cancer care equity nationally and globally.

Disparities in access to cancer diagnostics in ASEAN member countries.

Diagnostics, including laboratory tests, medical and nuclear imaging, and molecular testing, are essential in the diagnosis and management of cancer to optimize clinical outcomes. With the continuous rise in cancer mortality and morbidity in the Association of Southeast Asian Nations (ASEAN), there exists a critical need to evaluate the accessibility of cancer diagnostics in the region so as to direct multifaceted interventions that will address regional inequities and inadequacies in cancer care. This paper identifies existing gaps in service delivery, health workforce, health information systems, leadership and governance, and financing and how these contribute to disparities in access to cancer diagnostics in ASEAN member countries. Intersectoral health policies that will strengthen coordinated laboratory services, upscale infrastructure development, encourage health workforce production, and enable proper appropriation of funding are necessary to effectively reduce the regional cancer burden.

Breast and cervical cancer screening in the Philippines: Challenges and steps forward.

In 2020, breast and cervical cancer were the top 2 cancers among Filipino women in terms of incidence. In the Philippines, a lower-middle income country in Southeast Asia with more than 50 million women, majority of breast and cervical cancer patients are diagnosed at advanced stages, as high out-of-pocket healthcare costs, the centralization of health human resources and infrastructure in the capital, and the absence of organized national screening programs preclude access to breast and cervical cancer screening. Low health literacy and gendered sociocultural pressures among Filipino women compound these systemic challenges. The recent passage of the Universal Health Care Law and the National Integrated Cancer Control Act in the Philippines is an opportunity to reduce disparities in access to cancer screening, with implications for other low- and middle-income countries that may face parallel challenges.

Assessing the effect of the COVID-19 pandemic, shift to online learning, and social media use on the mental health of college students in the Philippines: A mixed-method study protocol.

INTRODUCTION: The COVID-19 pandemic declared by the WHO has affected many countries rendering everyday lives halted. In the Philippines, the lockdown quarantine protocols have shifted the traditional college classes to online. The abrupt transition to online classes may bring psychological effects to college students due to continuous isolation and lack of interaction with fellow students and teachers. Our study aims to assess Filipino college students' mental health status and to estimate the effect of the COVID-19 pandemic, the shift to online learning, and social media use on mental health. In addition, facilitators or stressors that modified the mental health status of the college students during the COVID-19 pandemic, quarantine, and subsequent shift to online learning will be investigated. METHODS AND ANALYSIS: Mixed-method study design will be used, which will involve: (1) an online survey to 2,100 college students across the Philippines; and (2) randomly selected 20-40 key informant interviews (KIIs). Online self-administered questionnaire (SAQ) including Depression, Anxiety, and Stress Scale (DASS-21) and Brief-COPE will be used. Moreover, socio-demographic factors, social media usage, shift to online learning factors, family history of mental health and COVID-19, and other factors that could affect mental health will also be included in the SAQ. KIIs will explore factors affecting the student's mental health, behaviors, coping mechanism, current stressors, and other emotional reactions to these stressors. Associations between mental health outcomes and possible risk factors will be estimated using generalized linear models, while a thematic approach will be made for the findings from the KIIs. Results of the study will then be triangulated and summarized. ETHICS AND DISSEMINATION: Our study has been approved by the University of the Philippines Manila Research Ethics Board (UPMREB 2021-099-01). The results will be actively disseminated through conference presentations, peer-reviewed journals, social media, print and broadcast media, and various stakeholder activities.