Unleashing talent in mental health sciences: gender equality at the top

Society is undergoing a shift in gender politics. Science and medicine are part of this conversation, not least as women's representation and pay continue to drop as one progresses through more senior academic and clinical levels. Naming and redressing these inequalities needs to be a priority for us all.Declaration of interestNone.

The Chemical Sciences and Equality, Diversity, and Inclusion

There has been mounting concern over the absence of gender equality in the sciences in recent years. This has been accompanied by a broadening of the perspective, in order to address issues of equality, diversity and inclusion, relating to a wide range of circumstances in which individuals suffer discrimination. While some progress has been made in some countries, nationally or at the level of institutions, much more needs to be done. The chemical sciences can play a leading role in addressing biases, through 1) becoming a model of good systemic practice in policies, processes, and actions; 2) developing practical skills through training in cultural competence; and 3) promoting a stronger evidence base to uncover both the extent of problems and the degree to which approaches to improve equality, diversity, and inclusion are working.

Gender differences in egalitarian behavior and attitudes in early childhood

It is axiomatic that human females are more egalitarian than males. However, surprisingly little empirical research exists that empirically assesses this stereotype. We created two studies designed to objectively examine egalitarian behavior in 3- to 5-year-old children. In Study 1 we compared the egalitarian behavior and attitudes of American girls versus boys by tabulating the extent to which each gender awarded the same number of stickers to, and liked to the same degree, two puppets. One puppet followed the child's instructions or actions while the other did not during a drawing task in which the child played the roles of leader and peer. In the peer role, girls exhibited more egalitarian behavior than boys. In Study 2, French-Canadian children were shown two drawings by unknown peers-one messily and one neatly colored-, then asked to distribute stickers to each peer's drawing. Again, girls exhibited more egalitarian behavior than boys. Results suggest the origins of gender differences in egalitarian behavior occur early in life and merit further investigation.

Disapproved, but Tolerated: The Role of Respect in Outgroup Tolerance

We conducted two studies to test the hypothesis that respect for disapproved outgroups increases tolerance toward them. In Study 1, we employed a panel sample of supporters of the Tea Party movement in the United States and found that Tea Party supporters' respect for homosexuals and Muslims as equal fellow citizens positively predicted Tea Party supporters' tolerance toward these groups. There was no indication that alternative recognition processes (i.e., achievement recognition or need recognition) played a similar role in the development of tolerance. Study 2 replicated the respect-tolerance link with the experimental method and a more comprehensive measure of tolerance. In particular, it demonstrated that the link also holds with regard to tolerance in the public or political sphere. The wider implications of our research for societal pluralism are discussed.

Bridging the Gap: Identifying Global Trends in Gender Disparity Among the Radiology Physician Workforce

RATIONALE AND OBJECTIVES

Women make up half of American medical school graduates, but remain underrepresented among radiologists. This study sought to determine whether workforce gender disparities exist in other countries, and to identify any country-specific indices associated with increased female representation.

MATERIALS AND METHODS

In this cross-sectional study, 95 professional radiology organizations in 75 countries were contacted via email to provide membership statistics, including proportion of female members, female members aged 35 or under, and women in society leadership positions. Country-specific metrics collected included gross domestic product, Gini index, percent female medical school enrollment, and Gender Development Index for the purposes of univariate multiple regression analysis.

RESULTS

Twenty-nine organizations provided data on 184,888 radiologists, representing 26 countries from Europe (n = 12), North America (n = 2), Central/South America (n = 6), Oceania (n = 2), Asia (n = 3), and Africa (n = 1) for a response rate of 34.7% (26/75). Globally, 33.5% of radiologists are female. Women constitute a higher proportion of younger radiologists, with 48.5% of radiologists aged 35 or under being female. Female representation in radiology is lowest in the United States (27.2%), highest in Thailand (85.0%), and most variable in Europe (mean 40.1%, range 28.8%-68.9%). The proportion of female radiologists was positively associated with a country's Gender Development Index (P = .006), percent female medical student enrollment (P = .001), and Gini index (P = .002), and negatively associated with gross domestic product (P = .03).

CONCLUSIONS

Women are underrepresented in radiology globally, most notably in the United States. Countries with greater representation of women had higher gender equality and percent female medical school enrollment, suggesting these factors may play a role in the gender gap.

The INHERIT Model: A Tool to Jointly Improve Health, Environmental Sustainability and Health Equity through Behavior and Lifestyle Change

The need for analysis and action across the interrelated domains of human behaviors and lifestyles, environmental sustainability, health and inequality is increasingly apparent. Currently, these areas are often not considered in conjunction when developing policies or interventions, introducing the potential for suboptimal or conflicting outcomes. The INHERIT model has been developed within the EU-funded project INHERIT as a tool to guide thinking and intersectoral action towards changing the behaviors and lifestyles that play such an important role in today’s multidisciplinary challenges. The model integrates ecological public health and behavioral change models, emphasizing inequalities and those parts of the causal process that are influenced by human behaviors and lifestyles. The model was developed through web-based and live discussions with experts and policy stakeholders. To test the model’s usability, the model was applied to aspects of food consumption. This paper shows that the INHERIT model can serve as a tool to identify opportunities for change in important −food-related behaviors and lifestyles and to examine how they impact on health, health inequalities, and the environment in Europe and beyond. The INHERIT model helps clarify these interrelated domains, creating new opportunities to improve environmental health and health inequality, while taking our planetary boundaries into consideration.

A Darker Side of Hope: Harmony-Focused Hope Decreases Collective Action Intentions Among the Disadvantaged

Hope is viewed as a positive emotion associated with the motivation to change existing conditions. As such, it is highly relevant for social change, particularly when considering disadvantaged groups. We propose that, in the context of unequal intergroup relations, hope may actually undermine motivation for change among disadvantaged group members. Specifically, we distinguish between hope targeted at harmony with the outgroup and hope targeted at social equality between groups. Drawing on insights regarding the consequences of positive intergroup interactions, we predict that hope for harmony with the outgroup can undermine the constructive tension that motivates the disadvantaged toward equality. Across four studies, involving different intergroup contexts, hope for harmony was negatively associated with disadvantaged group members' motivation for collective action. We further found that high identifiers from the disadvantaged group were immune to this effect. We discuss theoretical and practical implications for the role of hope in social change.

Relationship between sociodemographic factors and selection into UK postgraduate medical training programmes: a national cohort study

INTRODUCTION

Knowledge about allocation of doctors into postgraduate training programmes is essential in terms of workforce planning, transparency and equity issues. However, this is a rarely examined topic. To address this gap in the literature, the current study examines the relationships between applicants' sociodemographic characteristics and outcomes on the UK Foundation Training selection process.

METHODS

A longitudinal, cohort study of trainees who applied for the first stage of UK postgraduate medical training in 2013-2014. We used UK Medical Education Database (UKMED) to access linked data from different sources, including medical school admissions, assessments and postgraduate training. Multivariable ordinal regression analyses were used to predict the odds of applicants being allocated to their preferred foundation schools.

RESULTS

Applicants allocated to their first-choice foundation school scored on average a quarter of an SD above the average of all applicants in the sample. After adjusting for Foundation Training application score, no statistically significant effects were observed for gender, socioeconomic status (as determined by income support) or whether applicants entered medical school as graduates or not. Ethnicity and place of medical qualification were strong predictors of allocation to preferred foundation school. Applicants who graduated from medical schools in Wales, Scotland and Northern Ireland were 1.17 times, 3.33 times and 12.64 times (respectively), the odds of applicants who graduated from a medical school in England to be allocated to a foundation school of their choice.

CONCLUSIONS

The data provide supportive evidence for the fairness of the allocation process but highlight some interesting findings relating to 'push-pull' factors in medical careers decision-making. These findings should be considered when designing postgraduate training policy.

Embedding gender equality into institutional strategy

The SiS (Sex in Science) Programme on the WGC (Wellcome Genome Campus) was established in 2011. Key participants include the Wellcome Trust Sanger Institute, EMB-EBI (EMBL-European Bioinformatics Institute), Open Targets and Elixir. The key objectives are to catalyse cultural change, develop partnerships, communicate activities and champion our women in science work at a national and international level (http://www.sanger.ac.uk/about/sex-science). In this paper, we highlight some of the many initiatives that have taken place since 2013, to address gender inequality at the highest levels; the challenges we have faced and how we have overcome these, and the future direction of travel.

Performance-Enhancing Drugs, Sport, and the Ideal of Natural Athletic Performance

The use of certain performance-enhancing drugs (PED) is banned in sport. I discuss critically standard justifications of the ban based on arguments from two widely used criteria: fairness and harms to health. I argue that these arguments on their own are inadequate, and only make sense within a normative understanding of athletic performance and the value of sport. In the discourse over PED, the distinction between "natural" and "artificial" performance has exerted significant impact. I examine whether the distinction makes sense from a moral point of view. I propose an understanding of "natural" athletic performance by combining biological knowledge of training with an interpretation of the normative structure of sport. I conclude that this understanding can serve as moral justification of the PED ban and enable critical and analytically based line drawing between acceptable and nonacceptable performance-enhancing means in sport.

Gender and Publishing in Nursing: a secondary analysis of h-index ranking tables

AIMS

To analyse published ranking tables on academics' h-index scores to establish whether male nursing academics are disproportionately represented in these tables compared with their representation across the whole profession.

BACKGROUND

Previous studies have identified a disproportionate representation of UK male nursing academics in publishing in comparison to their US counterparts.

DESIGN

Secondary statistical analysis, which involved comparative correlation of proportions.

METHODS

Four papers from the UK, Canada and Australia containing h-index ranking tables and published between 2010-2017, were re-analysed in June 2017 to identify authors' sex. Pearson's chi-squared test was applied to ascertain whether the number of men included in the tables was statistically proportionate to the number of men on the pertinent national professional register.

FINDINGS

There was a disproportionate number of men with high h-index scores in the UK and Canadian data sets, compared with the proportion of men on the pertinent national registers. The number of men in the Australian data set was proportionate with the number of men on the nursing register. There was a disproportionate number of male professors in UK universities.

CONCLUSION

The influence of men over nursing publishing in the UK and Canada outweighs their representation across the whole profession. Similarly, in the UK, men's representation in the professoriate is disproportionately great. However, the Australian results suggest that gender inequality is not inevitable and that it is possible to create more egalitarian nursing cultures. This article is protected by copyright. All rights reserved.

The Ethics of End-of-Trial Obligations in a Pediatric Malaria Vaccine Trial: The Perspectives of Stakeholders From Ghana and Tanzania

This study explores stakeholder experiences and perspectives on end-of-trial obligations at the close of a phase II/III Pediatric Malaria Vaccine Trial (PMVT) [GSK/PATH-MVI RTS, S) (NCT00866619]. We conducted 52 key informant interviews with major stakeholders of an international multicentre PMVT in Ghana and Tanzania. The responses fell into four main themes: (a) Communicating End-of-Trial, (b) Maintaining Health Care Services, (c) Dissemination of Results, and (d) Post-Trial Access. Interviewee responses shared important practical experiences and insights that complement current thinking in the literature on research ethics guidance: (a) accompany end-of-trial communication with information on personal and family health care responsibilities, (b) establish public health indicators to measure the impact of research on a health care system,

[Justice and access to care]

Evoking justice in the field of care can be paradoxical considering the natural inequalities inherent to health. This article reflects on whether the use of the term justice in relation to access to care refers to equality or equity.

A systematic review of interventions to support the careers of women in academic medicine and other disciplines

OBJECTIVE

To summarise quantitative evaluations of interventions designed to support the careers of women in academia of any discipline.

METHOD

A systematic search of English entries in PubMed, CINAHL and Google Scholar was conducted in September 2017. Methodological quality of the studies was independently assessed by two authors using the Joanna Briggs Institute quality appraisal checklists. Meta-analysis was not possible due to heterogeneity in methods and outcomes; results were synthesised and displayed narratively.

RESULTS

Eighteen eligible studies were identified, mostly evaluating programmes in academic medicine departments. The most common interventions were mentoring, education, professional development and/or networking programmes. All programmes took a 'bottom-up' approach in that women were responsible for opting into and devoting time to participation. Study quality was low overall, but all studies reported positive outcomes on at least one indicator. Most often this included improvements in self-rated skills and capabilities, or satisfaction with the programme offered. Results regarding tangible outcomes were mixed; while some studies noted improvements in promotion, retention and remuneration, others did not.

CONCLUSIONS

This review suggests that targeted programmes have the potential to improve some outcomes for women in academia. However, the studies provide limited high-quality evidence to provide information for academic institutions in terms of the best way to improve outcomes for women in academia. The success of an intervention appears to be undermined when it relies on the additional labour of those it is intending to support (ie, 'bottom-up' approaches). As such, academic institutions should consider and evaluate the efficacy of 'top-down' interventions that start with change in practice of higher management.

Organisational perspectives on addressing differential attainment in postgraduate medical education: a qualitative study in the UK

OBJECTIVES

To explore how representatives from organisations with responsibility for doctors in training perceive risks to the educational progression of UK medical graduates from black and minority ethnic groups (BME UKGs), and graduates of non-UK medical schools (international medical graduates (IMGs)). To identify the barriers to and facilitators of change.

DESIGN

Qualitative semistructured individual and group interview study.

SETTING

Postgraduate medical education in the UK.

PARTICIPANTS

Individuals with roles in examinations and/or curriculum design from UK medical Royal Colleges. Employees of NHS Employers.

RESULTS

Representatives from 11 medical Royal Colleges (n=29) and NHS Employers (n=2) took part (55% medically qualified, 61% male, 71% white British/Irish, 23% Asian/Asian British, 6% missing ethnicity). Risks were perceived as significant, although more so for IMGs than for BME UKGs. Participants based significance ratings on evidence obtained largely through personal experience. A lack of evidence led to downgrading of significance. Participants were pessimistic about effecting change, two main barriers being sensitivities around race and the isolation of interventions. Participants felt that organisations should acknowledge problems, but felt concerned about being transparent without a solution; and talking about race with trainees was felt to be difficult. Participants mentioned 63 schemes aiming to address differential attainment, but these were typically local or specialty-specific, were not aimed at BME UKGs and were largely unevaluated. Participants felt that national change was needed, but only felt empowered to effect change locally or within their specialty.

CONCLUSIONS

Representatives from organisations responsible for training doctors perceived the risks faced by BME UKGs and IMGs as significant but difficult to change. Strategies to help organisations address these risks include: increased openness to discussing race (including ethnic differences in attainment among UKGs); better sharing of information and resources nationally to empower organisations to effect change locally and within specialties; and evaluation of evidence-based interventions.

What Facilitates "Patient Empowerment" in Cancer Patients During Follow-Up: A Qualitative Systematic Review of the Literature

Empowerment is a concept of growing importance in cancer care, but little is known about cancer patients' experiences of empowerment during follow-up. To explore this area, a qualitative systematic literature review was conducted in PubMed, CINAHL, and PsycINFO. A total of 2,292 papers were identified and 38 articles selected and included in the review. The thematic synthesis of the papers resulted in seven analytical themes being identified: empowerment as an ongoing process, knowledge is power, having an active role, communication and interaction between patients and health care professionals, support from being in a group, religion and spirituality, and gender. Very few articles explicitly explored the empowerment of cancer patients during follow-up, and the review identified a lack of attention to patients' own understandings of empowerment, a lack of specific focus on empowerment during follow-up, and insufficient attention to collective empowerment, as well as ethnic, social, and gender differences.

Positive bias for European men in peer reviewed applications for faculty position at Karolinska Institutet

Background: Sweden is viewed as an egalitarian country, still most of the professors are Swedish and only 25% are women. Research competence is evaluated using peer review, which is regarded as an objective measure in the meritocracy system. Here we update the investigation by Wold & Wennerås (1997) on women researcher’s success rate for obtaining a faculty position, by examining factors (gender, nationality, productivity, etc.) in applications for an Assistant Professorship in 2014 at Karolinska Institutet.

Methods: Fifty-six applications, 26 Swedish and 21 women applicants, were scored both on merits and projects by six external reviewers. Additional variables, including grants and academic age, calculated as the number of years since PhD excluding parental or sick leave, were gathered. Productivity was assessed by calculating a composite bibliometric score based on six factors (citations, publications, first/last authorships, H-index, high impact publication).

Results: Overall, academic age was negatively correlated with scores on merits, as assessed by peer review, although not reaching statistical significance. In men, associations between scores on merits and productivity ( P-value=0.0004), as well as having received grants ( P-value=0.009) were seen. No associations were found for women. Moreover, applicants with a background from the Middle East were un-proportionally found in the lowest quartile (Fisher exact test P-value=0.007).

Conclusions: In summary, the gender inequality shown in peer review processes in Sweden 20 years ago still exists. Furthermore, a bias for ethnicity was found. In order to keep the best scientific competence in academia, more efforts are needed to avoid selection bias in assessments to enable equal evaluations of all researchers.

That's what friends are for: how intergroup friendships promote historically disadvantaged groups' substantive political representation

The interests of historically disadvantaged groups risk being overlooked if they are not present in the decision-making process. However, a mere presence in politics does not guarantee political success. Often groups need allies to promote their interests successfully. We argue that one way to identify such allies is to judge politicians by whether they have friends in historically disadvantaged groups, as intergroup friendships have been shown to make people understand and feel empathy for outgroups. In other words, intergroup friendships may function as an important complement to descriptive representation. We test our argument with a unique survey that asks all elected political representatives in Sweden's 290 municipalities (response rate 79 per cent) about their friendship ties to, and their representation of, five historically disadvantaged groups: women, immigrants, youths, pensioners and blue-collar workers. We find a strong correlation between representatives' friendship ties to these groups and their commitment to represent them. The correlation is especially strong for youths and blue-collar workers, which likely can be explained by the fact that these groups usually lack crucial political resources (such as experience and education). We conclude that friendship ties function as an important complement to descriptive representation for achieving substantive representation.

The Case for Same-Sex Marriage Before the European Court of Human Rights

For proponents of same-sex marriage, this essay sets forward a critical analysis of relevant arguments before the European Court of Human Rights. The privacy aspect of Article 8 European Convention of Human Rights will never be a successful argument with reference to marriage, which involves a public status. The equality argument (Article 14) is useful in addressing this issue with its close connections with citizenship, symbolic value, and proven record internationally. Difficulties remain with the equality argument; its conditional status, the width of the margin of appreciation allocated, and the need for an equality comparator. The equality argument needs reinforcement by use alongside a developing family law argument under Article 8 and a dynamically interpreted Article 12 (right to marry) argument. Ultimately, the success of any argument depends on convincingly influencing the European Court to consider that sufficient consensus has developed among Member States of the Council of Europe.

Testing Equality: Insanity, Treatment Refusal and the CRPD

The Convention on the Rights of Persons with Disabilities is considered to be a radical international treaty that affords persons with disability recognition and protection of equal rights in socio-cultural, political, medical and legal arenas. Drawing from the Convention's core principles of equality and non-discrimination, the High Commissioner for Human Rights and the Convention's Committee have called for a replacement of the insanity defence with a disability-neutral doctrine. The rationale is that retaining this special defence is, in itself, discriminatory, given its function is necessarily based on the presence of mental disability and the assumption that such disabilities impair capacity and reasoning. This article interrogates the rationale behind 'abolitionist' views, and asks whether equality necessarily means treating all persons identically regardless of capacity to reason about conduct.

Protecting Pregnant Workers while Fighting Sexism: Work-Pregnancy Balance and Pregnant Nurses' Resistance in Québec Hospitals: Protéger les travailleuses enceintes en luttant contre le sexisme: équilibre travail-grossesse et résistance d'infirmières enceintes dans des hôpitaux québécois

Women's workplaces should guarantee healthy pregnancies while supporting pregnant women as workers. In Québec (Canada), a pregnant worker exposed to a "danger" for herself or her fetus may ask her employer to be reassigned to other work appropriate to her skills. This approach differs from other regulatory contexts in North America in that protection of fetal and maternal health is embedded in the health and safety legislation. The advantage is that the pregnant worker is guaranteed access to her full salary, but some may question whether specific provisions for pregnant women single out such women and produce risks for their careers or, conversely, pregnancy should receive even more special consideration. These questions are discussed using the results of a qualitative analysis of interviews with pregnant nurses, their supervisors, and their union representatives in ten hospitals in Québec. We think that the management of pregnancy under this legislation generally protects health, but that, in the absence of true employer commitment to the health of all workers, undue burdens may be placed upon other members of the work team. Résumé Les lieux de travail des femmes devraient garantir des grossesses saines tout en soutenant les femmes enceintes en tant que travailleurs. Au Québec (Canada), une travailleuse enceinte exposée à un danger pour elle-même ou son fœtus peut demander à son employeur d'être réaffectée à d'autres tãches sans danger et adaptéches à ses compétences. Cette approche diffère des autres contextes réglementaires en Amérique du Nord en ce sens que la protection de la santé foetale et maternelle est intégrée dans la législation sur la santé et la sécurité. Certains peuvent se demander si des dispositions spécifiques pour les femmes enceintes singularisent ces travailleuses et contribuent à la précarisation de leur emploi. Ou, à l'inverse, si la grossesse devrait recevoir une considération encore plus spéciale. Ces questions sont discutées à la lumière du récit d infirmières enceintes, de gestionnaires et de représentants syndicaux responsables des dossiers de conciliation travail-grossesse dans dix hôpitaux du Québec. Nous constatons que la gestion de la grossesse en vertu de cette législation est généralement protectrice de la santé, mais qu'en l'absence d'un véritable engagement de l'employeur envers la santé de tous les travailleurs, des charges excessives peuvent être imposées aux autres membres de l'équipe de travail.

[Telemedicine in current nursing practices]

The first priority telemedicine programme focused, from 2011, on five areas, with the aim of guaranteeing equal access to care to everybody across a healthcare region. Experiments were financed by public authorities. These practices are now integrated into the organisation of healthcare.

The cancer care experiences of gay, lesbian and bisexual patients: A secondary analysis of data from the UK Cancer Patient Experience Survey

Understanding the effects of population diversity on cancer-related experiences is a priority in oncology care. Previous research demonstrates inequalities arising from variation in age, gender and ethnicity. Inequalities and sexual orientation remain underexplored. Here, we report, for the first time in the UK, a quantitative secondary analysis of the 2013 UK National Cancer Patient Experience Survey which contains 70 questions on specific aspects of care, and six on overall care experiences. 68,737 individuals responded, of whom 0.8% identified as lesbian, gay or bisexual. Controlling for age, gender and concurrent mental health comorbidity, logistic regression models applying post-estimate probability Wald tests explored response differences between heterosexual, bisexual and lesbian/gay respondents. Significant differences were found for 16 questions relating to: (1) a lack of patient-centred care and involvement in decision-making, (2) a need for health professional training and revision of information resources to negate the effects of heteronormativity and (3) evidence of substantial social isolation through cancer. These findings suggest a pattern of inequality, with less positive cancer experiences reported by lesbian, gay and (especially) bisexual respondents. Poor patient-professional communication and heteronormativity in the healthcare setting potentially explain many of the differences found. Social isolation is problematic for this group and warrants further exploration.

Deliberation favours social efficiency by making people disregard their relative shares: evidence from USA and India

Groups make decisions on both the production and the distribution of resources. These decisions typically involve a tension between increasing the total level of group resources (i.e. social efficiency) and distributing these resources among group members (i.e. individuals' relative shares). This is the case because the redistribution process may destroy part of the resources, thus resulting in socially inefficient allocations. Here we apply a dual-process approach to understand the cognitive underpinnings of this fundamental tension. We conducted a set of experiments to examine the extent to which different allocation decisions respond to intuition or deliberation. In a newly developed approach, we assess intuition and deliberation at both the trait level (using the Cognitive Reflection Test, henceforth CRT) and the state level (through the experimental manipulation of response times). To test for robustness, experiments were conducted in two countries: the USA and India. Despite absolute-level differences across countries, in both locations we show that: (i) time pressure and low CRT scores are associated with individuals' concerns for their relative shares and (ii) time delay and high CRT scores are associated with individuals' concerns for social efficiency. These findings demonstrate that deliberation favours social efficiency by overriding individuals' intuitive tendency to focus on relative shares.

Same but different: Comparative modes of information processing are implicated in the construction of perceptions of autonomy support

An implicit assumption behind tenets of self-determination theory is that perceptions of autonomy support are a function of absolute modes of information processing. In this study, we examined whether comparative modes of information processing were implicated in the construction of perceptions of autonomy support. In an experimental study, we demonstrated that participants employed comparative modes of information processing in evaluating receipt of small, but not large, amounts of autonomy support. In addition, we found that social comparison processes influenced a number of outcomes that are empirically related to perceived autonomy support such as sense of autonomy, positive affect, perceived usefulness, and effort. Findings shed new light upon the processes underpinning construction of perceptions related to autonomy support and yield new insights into how to increase the predictive validity of models that use autonomy support as a determinant of motivation and psychological well-being.