The gender wage gap among health care workers across educational and occupational groups.

Women perform 77% of health care jobs in the United States, but gender inequity within the health care sector harms women's compensation and advancement in health care jobs. Using data from 2003 to 2021 of the Annual Social and Economic Supplement of the Current Population Survey (CPS), we measured women's representation and the gender wage gap in health care jobs by educational level and occupational category. We found, descriptively, that women's representation in health care occupations has increased over time in occupations that require a master's or doctoral/professional degree (eg, physicians, therapists), while men's representation has increased slightly in nursing occupations (eg, registered nurses, LPNs/LVNs, aides, and assistants). The adjusted wage gap between women and men is the largest among workers in high-education health care (eg, physicians, advanced practitioners) but has decreased substantially over the last 20 years, while, descriptively, the gender wage gap has stagnated or grown larger in some lower education occupations. Our policy recommendations include gender equity reviews within health care organizations, prioritizing women managers, and realigning Medicare and Medicaid reimbursement policies to promote greater gender equity within and across health care occupations.

Gender Inequity in Clinical Clerkships and its Influence on Career Selection: A Cross-Sectional Survey.

Objective: The aim of this study was to identify the frequency, form, and underlying factors contributing to gender inequity experienced by medical undergraduates and assess its influence on their career choices. Method: This was a cross-sectional, retrospective survey with a 100% response rate. This survey was distributed among medical students of clinical years in Karachi's private and government medical colleges from September 10th, 2021-March 30th, 2022. 430 participants were enrolled using a simple-random-sampling-technique. Chi-square/Fisher's Exact tests are employed to assess the relationships between gender and gender-based inequity in various specialties, including their characteristics, influence on career choices, adverse psychological effects, and potential mitigation strategies. Results: Among 430 respondents, 28.6% were male, and 71.4% were female. 89.1% reported gender inequity, evenly distributed in government (80.4%) and private institutions (88.1%). The general surgery and gynecology disciplines stood out, each with a 56% prevalence. In gynecology and surgery clinical-clerkships, both genders experienced similar rates, with females at 54.5% and 42.3%, and males at 56.7% and 61.6%, respectively (P-value = .000*). Disrespect from staff/professors/patients (48.8%) was the most common manifestation, driven by factors like preferences (73.7%), gender superiority (62.6%), societal attitudes (54%), and cultural norms (50.9%). Furthermore, 82.6% of students reported that gender inequity had a negative impact on their career decision (Male = 82.9%;Female = 82.4%, P-value = .899). Additionally, gender inequity also caused demotivation (78.1%), poor self-esteem (67.2%), helplessness/hopelessness (48.6%), and frustration (45.8%). Conclusions: Gender inequity is widely prevalent in the clinical-clerkships, affecting medical students' career decisions and mental health, stressing the need to prioritize and implement solutions at the undergraduate clinical-clerkship level.

"I don't know if I can keep doing this": a qualitative investigation of surgeon burnout and opportunities for organization-level improvement.

Introduction: Burnout is a pressing issue within surgical environments, bearing considerable consequences for both patients and surgeons alike. Given its prevalence and the unique contextual factors within academic surgical departments, it is critical that efforts are dedicated to understanding this issue. Moreover, active involvement of surgeons in these investigations is critical to ensure viability and uptake of potential strategies in their local setting. Thus, the purpose of this study was to explore surgeons' experiences with burnout and identify strategies to mitigate its drivers at the level of the organization. Methods: A qualitative case study was conducted by recruiting surgeons for participation in a cross-sectional survey and semi-structured interviews. Data collected were analyzed using reflexive thematic analysis, which was informed by the Areas of Worklife Model. Results: Overall, 28 unique surgeons participated in this study; 11 surgeons participated in interviews and 22 provided responses through the survey. Significant contributors to burnout identified included difficulties providing adequate care to patients due to limited resources and time available in academic medical centers and the moral injury associated with these challenges. The inequitable remuneration associated with education, administration, and leadership roles as a result of the Fee-For-Service model, as well as issues of gender inequity and the individualistic culture prevalent in surgical specialties were also described as contributing factors. Participants suggested increasing engagement between hospital leadership and staff to ensure surgeons are able to access resources to care for their patients, reforming payment plans and workplace polities to address issues of inequity, and improving workplace social dynamics as strategies for addressing burnout. Discussion: The high prevalence and negative sequalae of burnout in surgery necessitates the formation of targeted interventions to address this issue. A collaborative approach to developing interventions to improve burnout among surgeons may lead to feasible and sustainable solutions.

Experiences with pregnancy and child-rearing, advice for future mothers, and suggestions for improving the system: a qualitative study of women in neurosurgery.

OBJECTIVE: Neurosurgery is among the most demanding and time-consuming occupations, and with diversity and inclusion initiatives only recently increasing the number of women in the field, efforts still need to be made to help neurosurgery become more accommodating for pregnancy and child-rearing. Thus, the present study sought to be the first to investigate this issue through in-depth qualitative interviews of women in neurosurgery. METHODS: A total of 33 female neurosurgeons participated in semistructured Zoom interviews. Cocoding and thematic analysis were conducted with interview transcripts to determine themes and corresponding subthemes with regard to these women's experiences with pregnancy and child-rearing, advice for future mothers in neurosurgery, and suggestions for improving the field of neurosurgery for those desiring children. RESULTS: Among the 33 participants, 22 (66.7%) had given birth to or adopted at least one child, had at least one stepchild, or were pregnant at the time of the interview. Three themes emerged regarding these 22 women's experiences with pregnancy and child-rearing: 1) challenges with the physiological changes of pregnancy, 2) feelings of guilt and anxiety, and 3) reliance on loved ones for childcare. Three themes emerged among these 22 women's advice for future mothers in neurosurgery: 1) set realistic expectations, 2) take control of your schedule, and 3) realize that there is no "right" time to start a family. Finally, two themes emerged among all 33 participants' suggestions for making neurosurgery more feasible for pregnancy and child-rearing: 1) revamping of on-site resources, and 2) improved guidance on family planning, childbearing, and maternity leave. The most prominent subtheme in the authors' study was a call for improved on-site daycare under the "revamping of on-site resources" theme, with a particular emphasis on 24/7 operation. CONCLUSIONS: The authors' data have illustrated the themes of the experiences and thoughts of women in a field where pregnancy and child-rearing are arguably the most challenging of any occupation. Resources such as improved on-site daycare and organized, program-specific information sets for future mothers appear to comprise a consensus of suggested solutions by the women directly experiencing these challenges. The authors' results may be useful in guiding system-wide changes that may improve the field of neurosurgery for current and future mothers.

Gender distribution of North American professional radiology society award recipients.

PURPOSE: Women remain underrepresented in radiology and there is a paucity of literature examining the recognition of their professional contributions to the discipline. The purpose of this study was to examine the gender distribution of award winners across all North American radiology societies. METHODS: The gender distribution of 1923 award recipients from 21 North American radiology societies between 1960 and 2021 was examined. Awards were divided into four categories: leadership, teaching, contribution to radiology, and promising new/young societal member. Primary outcome was the total proportion of awards received by gender. All data was compared to the gender distribution of working radiologists in North America. RESULTS: A total of 1923 award recipients were identified between 1960 and 2021. Seventy-nine percent of award recipients were men (n = 1527) and 21 % were women (n = 396). As of 1970, the proportion of women award recipients increased 0.55 % ± 0.07 % each year. The proportion of women receiving radiological awards after 2018 is equal to or surpassing the percentage of women radiologists. Women received 36.4 % of leadership, 33.6 % of promising new member, 30.1 % of teaching, and 14.4 % of lifetime contribution awards. CONCLUSIONS: In the last five years, the proportion of women receiving awards was equal to or greater than the proportion of women radiologists. Women received more leadership awards and fewer lifetime contributor awards compared to men.

Women of Color in the Health Professions: A Scoping Review of the Literature.

Women of color (WoC) in the health professions encounter challenges in advancement to higher positions, disparities in wages, discrimination, lack of expectation to achieve leadership positions, and absence of extensive support networks. Articles in the literature have addressed race and/or gender in the context of professional development. However, applying an intersectional lens or framework to better understand the contextual issues of professional development for WoC remains to be addressed. Thus, this scoping review aimed to (i) identify health professions literature that addresses disparities affecting WoC, and (ii) describe strategies and approaches to support WoC in the health professions. Methods: The literature searches were conducted in multiple databases, including PubMed and MEDLINE (Ovid); and Google and Google Scholar were used to "hand search" further articles including gray literature. Three independent reviewers reviewed and screened articles for inclusion in accordance with a guide. Search included articles on pharmacy or healthcare professions, published in English, and which met three content criteria: racial disparities/inequities, professional development/career advancement, and women or gender disparities Results: A total of 31 articles were included-medicine (17), nursing (1), pharmacy (7), other (4), and multiple health professions (2). Key findings included underrepresentation of women and minority groups, inequities in professional advancement and leadership positions for WoC, and greater dissatisfaction and attrition among minority and women professionals. Conclusion: WoC face unique and distinct challenges and barriers in their professional careers resulting from the intersectionality of not only race and gender, but also lived experiences and opportunities. Strategies to improve diversity and representation should include an intersectional framework or lens and be critically evaluated.

[Response to the COVID-19 Health Crisis from a Gender Perspective: Lessons Learned]. / Respuesta a la crisis sanitaria de la COVID-19 desde la perspectiva de género: lecciones aprendidas.

OBJECTIVE: To delve deeper from a gender perspective into the lessons learned during the COVID-19 pandemic to address future health crises. METHOD: Study with key informants with experience in public health and gender from the Ministerio de Sanidad, ministries of the autonomous communities, Institut Català de la Salut, Hospital de La Princesa, Escuela Andaluza de Salud Pública and Universidad País Vasco. SOURCE OF INFORMATION: individual open-ended questionnaire on health and health inequalities/gender inequalities related to COVID-19. After presenting the findings, the key informants group discussed them in a meeting until reaching a consensus on the lessons learned. RESULTS: The lack of clinical statistics by sex could compromise epidemiological surveillance, losing the opportunity to characterize the disease. The performance of essential services fell more on women, exhausting them with double and triple shifts; with the differences according to sex in the clinical presentation of COVID-19, and the criteria for hospitalization/admission to the intensive care unit, their access to health care decreased. Increased: gender violence and mental health problems; delaying recognition of the second effects of vaccines in women; partially due to information biases in clinical trials. The gender perspective was lacking in academic, healthcare, and health management areas. CONCLUSIONS: Women's gender dimensions determined their higher frequency of COVID-19 and played a fundamental role in its control. Broadly considering the lessons learned will strengthen prevention systems and be able to provide effective responses to future health crises.

In-depth exploration of challenges faced by women in the Turkish maritime industry: A qualitative study.

BACKGROUND: Women are underrepresented in the maritime industry compared to men. This sector continues to perpetuate gender discrimination and stereotypes, often overlooking women's physical competence. OBJECTIVE: To explore the multi-faceted challenges faced by Turkish female officers, unveiling the different dimensions of these challenges, and providing a comprehensive understanding of their experiences. METHODS: In-depth semi-structured interviews were conducted with 40 Turkish female officers actively working on seagoing vessels. The data were analyzed using MAXQDA software. RESULTS: The challenges faced by female officers were examined using content analysis. A total of 50 different codes were identified within 10 categories. The categories are gender inequality, violence, restriction of freedom, work-family conflict, mental health, physical differences, unsafe living space, insufficient communication with management, lack of psychometric testing and limited access to health services. CONCLUSION: By shedding light on the unique obstacles faced by female officers in Turkey, this study enhances our understanding of the underlying challenges and lays the groundwork for the implementation of effective policies and practices that promote the empowerment of women in the maritime industry.

Respuesta a la crisis sanitaria de la COVID-19 desde la perspectiva de género: lecciones aprendidas / Response to the COVID-19 Health Crisis from a Gender Perspective: Lessons Learned

Objetivo: Profundizar desde la perspectiva de género en las lecciones aprendidas durante la pandemia de COVID-19 para hacer frente a futuras crisis de salud. Método: Estudio con informantes clave con experiencia en salud pública y género del Ministerio de Sanidad, Consejerías de las comunidades autónomas, Institut Català de la Salut, Hospital de La Princesa, Escuela Andaluza de Salud Pública y Universidad del País Vasco. Fuente de información: cuestionario individual de respuestas abiertas sobre inequidades o desigualdades de género sanitarias y en salud relacionadas con la COVID-19. Tras presentar los hallazgos, el grupo de informantes clave se reunió y debatió hasta llegar a un consenso sobre las lecciones aprendidas. Resultados: La falta de estadísticas clínicas por sexo pudo comprometer la vigilancia epidemiológica, perdiendo una oportunidad para caracterizar la enfermedad. El desempeño de los servicios esenciales recayó más en las mujeres, extenuándolas con dobles y triples jornadas, lo cual, junto con las diferencias según sexo en la presentación clínica de la COVID-19 y los criterios de hospitalización y de ingreso en la unidad de cuidados intensivos, disminuyó su acceso a la atención sanitaria. Aumentaron la violencia de género y los problemas de salud mental, retrasando el reconocer los efectos secundarios de las vacunas en las mujeres parcialmente por sesgos de información en los ensayos clínicos. La perspectiva de género faltó en los ámbitos académicos, asistenciales y de gestión sanitaria. Conclusiones: Las dimensiones de género de las mujeres determinaron su mayor frecuencia de COVID-19 y desempeñaron un papel fundamental en su control. Considerar las lecciones aprendidas fortalecerá los sistemas de prevención y permitirá poder dar respuestas eficaces a futuras crisis de salud.(AU)

Objective: To delve deeper from a gender perspective into the lessons learned during the COVID-19 pandemic to address future health crises. Method: Study with key informants with experience in public health and gender from the Ministerio de Sanidad, ministries of the autonomous communities, Institut Català de la Salut, Hospital de La Princesa, Escuela Andaluza de Salud Pública and Universidad País Vasco. Source of information: individual open-ended questionnaire on health and health inequalities/gender inequalities related to COVID-19. After presenting the findings, the key informants group discussed them in a meeting until reaching a consensus on the lessons learned. Results: The lack of clinical statistics by sex could compromise epidemiological surveillance, losing the opportunity to characterize the disease. The performance of essential services fell more on women, exhausting them with double and triple shifts; with the differences according to sex in the clinical presentation of COVID-19, and the criteria for hospitalization/admission to the intensive care unit, their access to health care decreased. Increased: gender violence and mental health problems; delaying recognition of the second effects of vaccines in women; partially due to information biases in clinical trials. The gender perspective was lacking in academic, healthcare, and health management areas. Conclusions: Women's gender dimensions determined their higher frequency of COVID-19 and played a fundamental role in its control. Broadly considering the lessons learned will strengthen prevention systems and be able to provide effective responses to future health crises.(AU)

Healthcare disparities in pituitary surgery: a systematic review.

OBJECTIVE: Pituitary surgery is a frequent neurosurgical procedure for the management of pituitary adenomas, but little research has been done on the impact of healthcare disparities on surgical results. Healthcare inequity/disparity in terms of race and socioeconomic status (SES), in addition to age and gender, was evaluated in this study to see if they affect the results of pituitary surgery. METHODS: A systematic literature search was carried out utilizing the MEDLINE (PubMed), Web of Science, Scopus, and Embase electronic databases from conception to 2023. The Newcastle-Ottawa Scale was used for quality assessment of the included studies. RESULTS: Twenty-one studies yielded a total of 381,643 patients, and removal of the studies with temporal overlap resulted in 134,832 patients with a mean ± SD age of 51.52 ± 0.41 years. Based on the available data, 46.63% of patients were male. Black patients were more likely to be recommended against surgery, while Asian or Pacific Islander patients were more likely to be recommended for surgery. Postoperative course and outcome showed mixed results, with some studies reporting higher rates of transient diabetes insipidus and stroke in racial minority populations. Private hospitals admitted more White patients, and certain racial groups had reduced access to high-volume centers. SES disparities were assessed in terms of insurance and income. Patients with government insurance or without insurance were more likely to be recommended active surveillance instead of definitive treatment. Furthermore, high SES was associated with a higher likelihood of receiving surgical treatment, better treatment outcomes, and better access to high-volume centers. In terms of age and gender disparity, older patients and females were less likely to be recommended for surgical treatment. Age and gender did not consistently impact postoperative course and treatment outcomes, with varying results across studies. No significant age and gender disparities were observed in hospital admissions and charges. CONCLUSIONS: This study revealed the presence of disparities in pituitary adenoma surgery based on race, SES, age, and gender. These disparities highlight the need for further research and interventions to ensure equitable access to appropriate surgical treatment and improved outcomes for all patients with pituitary adenomas.

Gender inequity in the medical profession: the women doctors in Spain (WOMEDS) study.

BACKGROUND: The long-standing underrepresentation of women in leadership positions in medicine is well-known, but poorly documented globally. There is some evidence of the gender gap in academia, medical society leadership, or specific problems in some specialties. However, there are no investigations analyzing all medical specialties together and reporting the glass ceiling from a 360º perspective that includes positions in academia, research, professional organizations, and clinical activity. Additionally, the majority of studies have a US perspective, and we wonder if the perspective of a European country might be different. The WOmen in MEDicine in Spain (WOMEDS) project ( https://womeds.es ) aims to describe and characterize, in a systematic and detailed way, the gender bias in the medical profession in Spain in order to monitor its evolution over time and contribute to prioritizing gender policies. METHODS: We retrieved data for the calendar years 2019-2021 from several sources and selected surveys. We built four groups of indicators to describe leadership positions in the medical profession: (i) leadership in healthcare according to specialty and region; (ii) leadership in scientific and professional bodies; (iii) academic career; and (iv) leadership in clinical research activity. As a summary measure, we reported the women ratios, calculated as the percentage of women in specific top positions divided by the percentage of women in the relevant population. RESULTS: We found gender inequity in leadership positions in all four settings. During the observed period, only 27.6% of the heads of departments in hospitals were women compared to 61.1% of women in medical staff. Ten of the 46 medical societies grouped in the Spanish Federation of Medical Societies (FACME) (21.7%) had a women president at some point during the study period, and only 4 annual congresses had ratios of women speakers higher than 1. Women were over-represented in the lower positions and underrepresented in the top academic ones. Only 26% and 27%, respectively, of the heads of departments and deans were women. The applications for public funding for research projects are led by women only in 45% of the cases, and the budget granted to women in public calls was 24.3% lower than that of men. CONCLUSION: In all the areas analyzed, the leadership positions are still mostly occupied by men despite the feminization of medicine in Spain. The severe gender inequity found calls for urgent interventions within a defined time horizon. Such measures must concern all levels, from national or regional regulation to changes in organizational culture or incentives in specific organizations.

RESUMEN EN ESPAÑOL: ANTECEDENTES: La prolongada infrarrepresentación de las mujeres en los puestos de liderazgo en medicina es bien conocida, pero está poco documentada de forma global. Hay evidencia sobre la brecha de género en la universidad, en el liderazgo en sociedades médicas o en determinadas especialidades. Sin embargo, no hay investigaciones que analicen el techo de cristal de cada una de las especialidades médicas desde una perspectiva 360º que incluya el liderazgo en la universidad, en la investigación con fondos públicos, en la representación en sociedades científicas y colegios profesionales y en la actividad clínica. Además, la mayoría de los estudios tienen una perspectiva estadounidense y nos preguntamos si la perspectiva de un país europeo podría ser diferente. El proyecto Mujeres en Medicina en España (WOMEDS) ( https://womeds.es ) tiene como objetivo describir y caracterizar de forma sistemática y detallada sesgo de género en la profesión médica en España, para monitorizar su evolución en el tiempo y contribuir a priorizar las políticas de género. MéTODOS: Construimos cuatro grupos de indicadores sobre liderazgo de mujeres médicos: (i) en la asistencia sanitaria; (ii) en las organizaciones científicas y profesionales; (iii) carrera académica, y; and (iv) l en la investigación basándonos en datos públicos y resultados de encuestas propias s referidas a los años 2019­2021. Como medida de análisis, calculamos los ratios de mujeres, definidos como el porcentaje de mujeres en puestos altos específicos dividido por el porcentaje de mujeres en la población relevante. RESULTADOS: Encontramos un sesgo de género en los cuatro ámbitos. Durante el periodo observado, solo el 27.6% de los jefes de servicio de los hospitales eran mujeres, frente al 61.1% de mujeres en la plantilla. Diez de las 46 sociedades médicas agrupadas en la Federación de Asociaciones Científico Médicas Españolas (FACME) (21.7%) tuvieron una mujer como presidente en algún momento del periodo de estudio y sólo 4 congresos anuales tenían ratios de mujeres ponentes superiores a 1. Las mujeres estaban sobrerepresentadas en los cargos inferiores e infrarrepresentadas en los cargos académicos superiores. Sólo el 26% y el 27%, respectivamente, de los jefes de departamento y decanos eran mujeres. La solicitud de proyectos de investigación con financiación pública fue liderada por mujeres en un 45% de los casos y la financiación media de los proyectos concedidos a las mujeres fue un 24.3% inferior a la de los hombres. CONCLUSIóN: En todos los ámbitos analizados, las posiciones de liderazgo siguen siendo mayoritariamente ocupada por varones a pesar de la feminización de la medicina. Para cambiar esto, será necesario tomar medidas, tanto regulatorias -a nivel nacional y nacional regional como promover cambios en la cultura organizativa o en los incentivos en organizaciones concretas.

Regional distribution in female representation in US otolaryngology faculty.

Objectives: To quantify the current proportion of women in otolaryngology at different levels of professorship and determine whether these proportions differ by US region. Methods: Academic rank and gender at all ACGME-accredited otolaryngology programs in the United States were determined from departmental websites, Doximity, and LinkedIn from November 2021 to March 2022. Individuals were then further organized using US Census Bureau-designated regions. Results: Among the 2682 faculty positions at 124 ACGME-accredited programs, women held 706 (26.3%) of these positions. Female representation was highest at the assistant professorship level, with women holding 286 (37.2%) positions out of a total 769. At the associate professorship level, women held 141 (27.6%) of the 511 total positions. The largest gender disparity is seen at the full professorship level; only 69 (13.6%) positions out of 508 were held by women. Out of every region and rank, only assistant professorship in the West had no significant difference in percentages of men and women (p = .710). Female representation of professors in the Northeast was significantly lower than that of our reference group (the South; ß = -10.9, p = .020). Conclusions: Otolaryngology has exhibited great progress in increasing female representation, with assistant professorship in the West reaching gender parity. However, the gender gap at other faculty levels still leaves much to be desired, particularly in senior ranks. The lack of otolaryngologists at senior ranks is detrimental to mentorship of junior faculty, residents, and medical students. Renewed efforts should be made to decrease the gender disparity in the South, Northeast, and particularly at the professorship level.

Exploring the Impact of COVID-19 on Women Hospitalists: A Mixed-Gender Qualitative Analysis.

BACKGROUND: Women physicians have faced persistent challenges, including gender bias, salary inequities, a disproportionate share of caregiving and domestic responsibilities, and limited representation in leadership. Data indicate the COVID-19 pandemic further highlighted and exacerbated these inequities. OBJECTIVE: To understand the pandemic's impact on women physicians and to brainstorm solutions to better support women physicians. DESIGN: Mixed-gender semi-structured focus groups. PARTICIPANTS: Hospitalists in the Hospital Medicine Reengineering Network (HOMERuN). APPROACH: Six semi-structured virtual focus groups were held with 22 individuals from 13 institutions comprised primarily of academic hospitalist physicians. Rapid qualitative methods including templated summaries and matrix analysis were applied to identify major themes and subthemes. KEY RESULTS: Four key themes emerged: (1) the pandemic exacerbated perceived gender inequities, (2) women's academic productivity and career development were negatively impacted, (3) women held disproportionate roles as caregivers and household managers, and (4) institutional pandemic responses were often misaligned with workforce needs, especially those of women hospitalists. Multiple interventions were proposed including: creating targeted workforce solutions and benefits to address the disproportionate caregiving burden placed on women, addressing hospitalist scheduling and leave practices, ensuring promotion pathways value clinical and COVID-19 contributions, creating transparency around salary and non-clinical time allocation, and ensuring women are better represented in leadership roles. CONCLUSIONS: Hospitalists perceived and experienced that women physicians faced negative impacts from the pandemic in multiple domains including leadership opportunities and scholarship, while also shouldering larger caregiving duties than men. There are many opportunities to improve workplace conditions for women; however, current institutional efforts were perceived as misaligned to actual needs. Thus, policy and programmatic changes, such as those proposed by this cohort of hospitalists, are needed to advance equity in the workplace.

Sex differences in patterns of referral and resource utilization in the cardiology clinic: an outpatient analysis.

Aims: Women may have different management patterns than men in specialised care. Our aim was to assess potential sex differences in referral, management and outcomes of patients attending outpatient cardiac consultations. Methods and results: Retrospective observational analysis of patients ≥18 years referred for the first time from primary care to a tertiary hospital cardiology clinic in 2017-2018, comparing reasons for referral, decisions and post-visit outcomes by sex.A total of 5,974 patients, 2,452 (41.0%) men aged 59.2 ± 18.6 years and 3,522 (59.0%) women aged 64.5 ± 17.9 years (P < 0.001) were referred for a first cardiology consultation. The age-related referral rates were higher in women. The most common reasons for consultation were palpitations in women (n = 676; 19.2%) and ECG abnormalities in men (n = 570; 23.2%). Delays to cardiology visits and additional tests were similar. During 24 months of follow-up, women had fewer cardiology hospitalisations (204; 5.8% vs. 229; 9.3%; P = 0.003) and lower mortality (65; 1.8% vs. 66; 2.7%; P = 0.028), but those aged <65 years had more emergency department visits (756; 48.5% vs. 560; 39.9%, P < 0.001) than men. Conclusion: There are substantial sex differences in primary care cardiology referral patterns, including causes, rates, decisions and outcomes, which are only partially explained by age differences. Further research is needed to understand the reasons for these differences.

The Careers and Professional Well-Being of Women Oncologists During the COVID-19 Pandemic: Responding for Tomorrow.

The COVID-19 pandemic exacerbated gender inequity in medicine, with women physicians reporting greater household responsibilities than their men counterparts and steeper barriers to career advancement. The pandemic highlighted the systemic assumptions and challenges faced by women physicians, which we anticipate is also true in our field of oncology. Prior literature suggests that women physicians were tasked with increased personal and professional responsibilities without compensation for their additional work, as well as derailments in career progression and significant burnout. Our aims are to highlight areas of opportunity to optimize the workplace experience of the oncology workforce and to invest in the professional well-being and sustainability of women oncologists as a step toward global workplace equity and future pandemic preparedness.

Are school-based interventions to prevent dating and relationship violence and gender-based violence equally effective for all students? Systematic review and equity analysis of moderation analyses in randomised trials.

School-based interventions for the prevention of dating and relationship violence (DRV) and gender-based violence (GBV) take advantage of universal opportunities for intervention. Information on differential effectiveness of interventions is important to assess if they ameliorate or worsen social gradients in specific outcomes. This is especially important in DRV and GBV prevention given the gendered context of these behaviours and their common aetiologies in patriarchal gender norms, and social acceptance in school contexts of sexual harassment, such as catcalling or unwanted groping. We undertook a systematic review of moderation analyses in randomised trials of school-based interventions for DRV and GBV prevention. We searched 21 databases and used supplementary search methods without regard to publication type, language or year of publication, and synthesised moderation tests relating to equity-relevant characteristics (principally sex and prior history of the outcome) for DRV and GBV perpetration and victimisation. Across 23 included outcome evaluations, programme effects on DRV victimisation were not moderated by gender or prior experience of DRV victimisation, but DRV perpetration outcomes were greater for boys, particularly for emotional and physical DRV perpetration. Findings for GBV outcomes were counterintuitive. Our findings suggest that practitioners should carefully monitor local intervention effectiveness and equity to ensure that interventions are working as intended. However, one of the most surprising findings from our analysis-with clear relevance for uncertainties in practice-was that differential impacts by sexuality or sexual minority status were not frequently evaluated.

Status of Women in Neurosurgery: Results from a National Survey in Italy.

Background: Gender inequity in surgery has increasingly been a matter of debate. Contributions of female neurosurgeons to academic medicine and societies are poorly highlighted. The aim of this study was to evaluate several aspects of the professional and work-life balance of female neurosurgeons in Italy. Methods: Data of the female neurosurgical population were extracted from a general 83-item questionnaire administered to a total of 3242 respondents. The survey was composed of multiple-choice questions investigating demographics, surgical training and practice, satisfaction, mentorship, discrimination, and harassment. Results: A total of 98 female neurosurgeons were included. Most responders were married or cohabiting (49%). Thirty-nine (43%) were planning to have children, and 15 of them (44%) stated the reason they still didn't have any was because of professional constraints. Seventy (71%) women were neurosurgeons with an academic position (residents or academics) and 28 (29%) were full-time attendings. Most of the female neurosurgeons are satisfied with their work: sometimes (35%), often (20%), and always or almost always (20%). Most of them (45%) stated they are rarely victims of harassment, but 66% think that they are treated differently because they are women. A similar rate for a poor and fulfilling work-life balance (34% and 35%, respectively) was detected. The majority of participants (89%) had encountered a role model during their career, but in only 11% of cases was that person female. Conclusions: Even though the rate of satisfaction among female neurosurgeons in Italy is high, some of them experienced gender discrimination, including incidents of sexual harassment and microaggressions. Policies including job sharing paradigms, consistent and meaningful options for parental leave, mentorship programs, equal and fair remuneration for equal work, and zero tolerance for harassment should be encouraged.

Canadian Women in Otolaryngology-Head and Neck Surgery part 1: the relationship of gender identity to career trajectory and experiences of harassment.

INTRODUCTION: Women in surgical specialties face different challenges than their male peers. However, there is a paucity of literature exploring these challenges and their effects on a Canadian surgeon's career. METHODS: A REDCap® survey was distributed to Canadian Otolaryngology-Head and Neck Surgery (OHNS) staff and residents in March 2021 using the national society listserv and social media. Questions examined practice patterns, leadership positions, advancement, and experiences of harassment. Gender differences in survey responses were explored. RESULTS: 183 completed surveys were obtained, representing 21.8% of the Canadian society membership [838 members with 205 (24.4%) women]. 83 respondents self-identified as female (40% response rate) and 100 as male (16% response rate). Female respondents reported significantly fewer residency peers and colleagues identifying as their gender (p < .001). Female respondents were significantly less likely to agree with the statement "My department had the same expectations of residents regardless of gender" (p < .001). Similar results were observed in questions about fair evaluation, equal treatment, and leadership opportunities (all p < .001). Male respondents held the majority of department chair (p = .028), site chief (p = .011), and division chief positions (p = .005). Women reported experiencing significantly more verbal sexual harassment during residency (p < .001), and more verbal non-sexual harassment as staff (p = .03) than their male colleagues. In both female residents and staff, this was more likely to originate from patients or family members (p < .03). DISCUSSION: There is a gender difference in the experience and treatment of OHNS residents and staff. By shedding light on this topic, as a specialty we can and must move towards greater diversity and equality.

Immunization Gender Inequity in Pakistan: An Analysis of 6.2 Million Children Born from 2019 to 2022 and Enrolled in the Sindh Electronic Immunization Registry.

Gender-based inequities in immunization impede the universal coverage of childhood vaccines. Leveraging data from the Government of Sindh's Electronic Immunization Registry (SEIR), we estimated inequalities in immunization for males and females from the 2019-2022 birth cohorts in Pakistan. We computed male-to-female (M:F) and gender inequality ratios (GIR) Tfor enrollment, vaccine coverage, and timeliness. We also explored the inequities by maternal literacy, geographic location, mode of vaccination delivery, and gender of vaccinators. Between 1 January 2019, and 31 December 2022, 6,235,305 children were enrolled in the SEIR, 52.2% males and 47.8% females. We observed a median M:F ratio of 1.03 at enrollment and at Penta-1, Penta-3, and Measles-1 vaccinations, indicating more males were enrolled in the immunization system than females. Once enrolled, a median GIR of 1.00 indicated similar coverage for females and males over time; however, females experienced a delay in their vaccination timeliness. Low maternal education; residing in remote-rural, rural, and slum regions; and receiving vaccines at fixed sites, as compared to outreach, were associated with fewer females being vaccinated, as compared to males. Our findings suggeste the need to tailor and implement gender-sensitive policies and strategies for improving equity in immunization, especially in vulnerable geographies with persistently high inequalities.

Women's Employment and Intimate Partner Violence: Understanding the Role of Individual and Community Structural Drivers in Low- and Middle-Income Countries.

Empirical findings on the relationship between women's employment and intimate partner violence (IPV) in low- and middle-income countries (LMICs) are mixed. These varied findings may arise because research thus far has given insufficient attention to how individual attributes and community context shape the pathways between women's employment and IPV. Using publicly available Demographic and Health Survey (DHS) data from 20 LMIC settings (n = 168,995), we investigate (1) how women's employment is associated with past-year IPV and (2) if associations differ by household- or community-level structural drivers of IPV: women's attitudes toward IPV, women's participation in household decision-making, and relative wealth. We fit mixed-effects logistic regression models exploring the total, individual, community, and contextual effects of women's employment on past-year IPV; effect measure modification by structural drivers; and cross-level interactions between community-level structural drivers and individual employment. Our analyses reveal positive associations between total (odds ratio [OR] = 1.31; 95% CI [1.27, 1.35]), individual (OR = 1.23; 95% CI [1.19, 1.27]), community (OR = 1.06; 95% CI [1.06, 1.07]), and contextual effects (OR = 1.04; 95% CI [1.03, 1.05]) of women's employment for IPV. Only individual wealth demonstrated statistically significant effect measure modification for the relationship between individual employment and past-year IPV (ratio of OR = 0.95; 95% CI [0.92, 0.99]). These findings suggest interventions that focus only on increasing women's employment may be associated with harmful increases in the occurrence of IPV, even when these interventions enable a large proportion of women in a community to be employed. Structural interventions that change norms of women's autonomy or attitudes toward IPV at the household or community levels may be insufficient to ameliorate these negative effects, whereas interventions that increase household wealth partly may buffer these effects.