Gender analysis of musculoskeletal disorders and emotional exhaustion: interactive effects from physical and psychosocial work exposures and engagement in domestic work

Using leisure crafting to reduce emotional exhaustion at home during the COVID-19 pandemic through better sleep and not thinking about the pandemic

Drawing on conservation of resources (COR) theory, we aimed to investigate whether leisure crafting reduces emotional exhaustion by improving sleep quality and strengthening psychological detachment from the coronavirus disease 2019 (COVID-19) pandemic. We posited that sleep quality and psychological detachment from the COVID-19 pandemic mediate the negative relationship between leisure crafting and emotional exhaustion. We carried out a two-wave longitudinal study among a group of individuals (N = 216) from Wuhan, China. We measured leisure crafting, sleep quality, and psychological detachment from the COVID-19 pandemic at Time 1 and emotional exhaustion two months later at Time 2. We discovered that leisure crafting reduced emotional exhaustion at home by improving sleep quality and increasing psychological detachment from the COVID-19 pandemic. At the end of this article, we discuss theoretical and practical implications, research limitations, and directions for future research.

Understanding risk factors for musculoskeletal disorders in Iranian housewives: Development of a comprehensive health promotion behavior model

BACKGROUND

Chronic musculoskeletal problems are a major source of disability, reduced productivity and poor quality of life. Prevalence of musculoskeletal disorders among Iranian housewives is particularly high. Understanding how housework causes the injuries, mobility restrictions and pain associated with musculoskeletal disorders is vital to developing health promotion behavior models to support intervention. The aim of this qualitative study was to explore the experiences of housewives with musculoskeletal disorders and, according to the risk factors identified, to develop a comprehensive behavior change framework to facilitate implementing a musculoskeletal health-promoting training intervention for women.

METHODS

Twenty-four in-depth interviews were conducted with Iranian housewives aged 20-65 years experiencing musculoskeletal pain over a 13-month period from September 2020 to October 2021. The conventional content analysis approach was used to interrogate the data. The transcript of each interview was considered a unit of analysis, and data analysis was performed using MAXQDA2018 software.

RESULTS

The analysis of the interview data provided 1432 meaning units. From these codes, a conceptual framework was developed. This comprehensive model is comprised of 24 subcategories, eight categories and three themes: Individual and social predictors of MSDs and their control, Risk factors for MSDs, and Prevention and treatment of MSDs. Altogether the developed conceptual framework specified the multiple risk factors for MSDs in housewives. The findings were aligned to various health promotion models, and it was seen that ecological models, especially the Theory of Triadic Influence, can be very helpful as a supportive roadmap to implementing multilateral interventions to improve the quality of life of housewives.

CONCLUSIONS

This study developed an evidence based comprehensive model that identifies the individual, psychosocial, and cultural factors that influence the status of MSDs in women's domestic work to support the development and implementation of effective ergonomic interventions to manage potentials for MSDs.

Using the Rapid Upper Limb Assessment to examine the effect of the new Hotel Housekeeping California Standard

A housekeeper's job includes a variety of repetitive and strenuous tasks, which can put workers at high risk for musculoskeletal disorders. In 2018, a new standard was implemented in California aiming to prevent work-related injuries of hospitality industry workers. This paper assesses California housekeepers performing regular work tasks during their shifts from 2018 to 2020. Rapid Upper Limb Assessments (RULA) after the standard was implemented found average right-arm scores for scrubbing tasks (M = 6.93, SD = 0.00), vacuuming (M = 6.27, SD = 0.45), and trash-collecting (M = 4.48, SD = 0.50). Forces to move housekeeping carts were also evaluated, with 98% of pushing forces and 73% of turning forces observed within the accepted range. Results show that RULA scores remain high even after the implementation of the standard, with improvements only seen in tasks that required just changing of the method.

Assessing the relationship between domestic work experience and musculoskeletal health among rural Nigerian women

BACKGROUND

Women performing strenuous domestic tasks (especially those in developing countries) are at risk of experiencing musculoskeletal pain (MSP). Physical, psychosocial, and social conditions of work in rural environments contribute to women's domestic work experiences (DWEs) and the risk of MSP. The impact of DWEs on women's health is especially severe in water-insecure countries like Nigeria. This study examines the relationship between a recently developed measure of DWEs and self-reported pain in the lower back (LBP), neck/shoulder (NSP), and elbow/hand/wrist regions (EHWP) among rural Nigerian women.

METHODS

Interviewer-administered survey data were collected from 356 women in four rural communities of Ibadan, Nigeria. Binary and ordinal logistic regression models were used to examine the relationship between DWE factor scores, sociodemographic characteristics, and musculoskeletal pain symptoms and severity after controlling for sociodemographic covariates. Effect estimates of association were presented using the odds ratio (OR), and the corresponding 95% confidence interval (CI) at p-value of 0.05.

FINDINGS

Among 356 participants, the 2-month prevalence of LBP was 58%, NSP was 30%, and EWHP 30%. High DWE scores were significantly associated with higher odds of experiencing and having more severe LBP, NSP, and EHWP. Specifically, the odds of LBP [(OR = 2.88; 95% CI = 1.64-5.11), NSP (OR = 4.58; 95% CI = 2.29-9.40) and EHWP (OR = 1.88; 95% CI = 1.26-3.77)] were significantly higher among women who perceived their domestic work responsibilities as very stressful (i.e., 'high stress appraisal') compared to those with lower stress appraisal scores. Those who were time-pressured and had less autonomy over familial duties (i.e., 'high demand/low control') had significantly higher odds of LBP [(OR = 2.58; 95% CI = 1.64-4.09) and NSP (OR = 1.49; 95% CI = 1.24-2.58)]. Frequently fetching and carrying water over long distances and time (i.e., 'high water sourcing and carriage') was also associated with higher odds of LBP [(OR = 1.31; 95% CI = 1.09-1.79) and NSP (OR = 1.20; 95% CI = 1.08-1.76).

CONCLUSION

Strenuous and stressful DWEs were associated with MSP among rural Nigerian women. This study provides new evidence on how the physical, social, and psychosocial factors of domestic work can increase women's risk of MSP.

Relationship between physical activity and musculoskeletal disorders among low income housewives in Kuala Lumpur: A cross sectional study

Housewives play a crucial role in their families’ and communities’ quality of life. However, musculoskeletal disorders are common among housewives due to housework and lack of physical activity. These musculoskeletal problems have been associated to leisure physical activity. As a result, the goal of this study was to determine the incidence of musculoskeletal problems and their association to physical activity among low-income women in Kuala Lumpur. A cross-sectional research was done among 82 housewives in Kuala Lumpur’s low-income housing area. Housewives were asked to fill out a sociodemographic questionnaire, a short version of the International Physical Activity Questionnaire (IPAQ), the Nordic Musculoskeletal Questionnaire (NMQ), and body mass index were measured by researcher. The total prevalence of musculoskeletal problems was found to be 89.0%, with the lowest frequency in the lower back (35%), followed by the knee (31%), ankle or foot (31%), and elbow (1% %). The subjects spent an average of 117.6 + 474.8 minutes per week on MVPA and 524 + 810.3 MET minutes per week on physical activity. A total of 88% of the participants had a low level of physical activity, 8.5 percent had a moderate level of activity, and 3.7% had a high level of activity. In a Chi-square test, there was no significant association between musculoskeletal problems and physical activity. The primary sociodemographic factors impacting musculoskeletal diseases were body mass index and household income, while the primary variables influencing physical activity were household income and education level, according to a logistic regression test. In a Poisson regression test, only body mass index had a significant relationship with number of musculoskeletal disorders. In conclusion, housewives are likely to suffer from musculoskeletal problems, with a high incidence in the lower back, knees, ankles, and feet, and the majority of them engage in little physical activity. Furthermore, the high percentage of musculoskeletal problems in this study varies with the findings of other research based on the type of housework done by housewives in low-cost housing areas. Future research should look at identifying the sorts of household tasks and positions employed, as well as the amount of hours spent on housework each week.

Which is the most ergonomic mop? A comparison of three domestic mopping systems

PURPOSE

To assess musculoskeletal risk factors (repetitions, posture, forces) of the upper limb during domestic floor mopping tasks.

METHODS

Two hundred women were surveyed to determine the most common mopping system, mopping patterns and type of flooring used in their homes. The biomechanical demands of the three most common mopping systems were then evaluated in the laboratory. Participants were also asked to rate their perceived levels of exertion and cleanliness of each mopping system.

RESULTS

The use of wet wipes had the highest repetition count and exertion rates during mopping and scrubbing tasks. Higher peak scrubbing forces were noted for the plunge mop. All participants found the cotton fibre mop to be the cleanest. All 3 mops had medium postural risk.

CONCLUSION

The advantages and disadvantages of each mopping system were outlined and may be used by occupational therapists when providing ergonomic advice to patients with upper limb musculoskeletal conditions.

Understanding Rural Women's Domestic Work Experiences (DWE) in Ibadan, Nigeria: Development of a Measurement Tool Using Confirmatory Factor Analysis

Gender norms prescribe domestic labor as primarily a female's responsibility in developing countries. Many domestic tasks depend on access to water, so the physical, emotional, and time demands of domestic labor may be exacerbated for women living in water-insecure environments. We developed a set of domestic work experience (DWE) measures tailored to work in rural areas in developing countries, assessed rural Nigerian women's DWE, and examined relationships among the measures. Interviewer-administered survey data were collected between August and September from 256 women in four rural Nigerian communities. Latent factors of DWE were identified by analyzing survey items using confirmatory factor analysis. Pearson's correlation was used to examine relationships among latent factor scores, and multivariate linear regression models were used to determine if factor scores significantly differed across socio-demographic characteristics. The DWE measures consisted of latent factors of the physical domain (frequency of common domestic tasks, water sourcing and carriage, experience of water scarcity), the psychosocial domain (stress appraisal and demand-control), and the social domain (social support). Significant correlations were observed among the latent factors within and across domains. Results revealed the importance of measuring rural Nigerian women's DWE using multiple and contextual approaches rather than relying solely on one exposure measure. Multiple inter-related factors contributed to women's DWE. Water insecurity exacerbated the physical and emotional demands of domestic labor DWE varied across age categories and pregnancy status among rural Nigerian women.

A meta-analysis of the association between physical demands of domestic labor and back pain among women

Background

Back pain (BP) is among the most common musculoskeletal problems globally and is a leading contributor to disability among adults. Millions of women especially those in low-income settings, engage in strenuous domestic activities that may increase their risk of BP. The purpose of this meta-analysis was to estimate the association between physically demanding domestic labor (PDDL) which is characterized as intensity, frequency, duration of work and biomechanical risk factors of work and BP among women.

Methods

Five databases were searched for records published from January 1991 to March 2020; and results from 11studies were included in the meta-analysis. A random effects model and the generic inverse-variance method was used to estimate the pooled odds ratio (OR), 95% confidence interval (CI), and the degree of heterogeneity among studies (I²). Stratified and sensitivity analyses were conducted to identify the influence of outliers and identify the sources of heterogeneity.

Results

Exposure to high PDDL was significantly associated with BP (OR = 1.63; 95% CI 1.30, 2.04; I² = 70%). The odds of back pain were highest among the following groups: women performing domestic labor in non-neutral postures (OR = 2.30; 95% CI = 1.75–3.04; I² = 0%; N = 4 studies) and among women from low- and middle-income countries (OR = 1.98; 95% CI = 1.58–2.49; I² = 29%; N = 5 studies). We found no evidence of publication bias (Egger’s test p-value = 0.15).

Conclusions

PDDL may significantly increase a woman’s risk of experiencing BP, but larger prospective studies are needed to further investigate the association. Presenting data on how domestic work affects the musculoskeletal health of women will be important in designing future interventions (behavioral, infrastructural, and ergonomic) that can reduce the burdens from domestic labor.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-021-01294-5.

Age- and Gender-Related Changes in Physical Function in Community-Dwelling Brazilian Adults Aged 50 to 102 Years

BACKGROUND AND PURPOSE

Cutoff points for physical function tests are commonly used in clinical practice for the evaluation, monitoring, and treatment of older adults. Previous studies have shown that, while age-related patterns of muscle strength change are similar between ethnic groups, strength values differ significantly independent of age. Whether the same applies to other physical function tests is presently unclear. This study investigated age- and gender-related changes of performance on a battery of physical function tests in Brazilian community dwellers.

METHODS

The study followed a cross-sectional design. Participants were community-dwelling adults. Candidates were considered eligible if they were 18 years or older, lived independently, and possessed sufficient physical and cognitive abilities to perform all of the measurements required by the protocol. Physical function tests included isometric handgrip (IHG), 5 times sit-to-stand (5×STS) test, Timed Up and Go, 1-leg stance, and walking speed (WS) at usual and fast pace.

RESULTS

Two-thousand eight-hundred and four people were enrolled. Mean age was 68.0 (7.0) years (range 50-102 years), and 2262 (80.7%) were women. Men displayed better IHG and balance, while women showed higher performance on the 5×STS and WS tests. A gender-specific pattern of decline in physical performance was observed. Specifically, women showed a linear age-dependent decline in all tests. In men, only in the IHG, 1-leg stance, and WS test at a fast pace was there a linear decline with age. In both genders, the lowest mean values of physical function tests were higher than the proposed cutoffs for sarcopenia.

DISCUSSION AND CONCLUSIONS

Our findings indicate that the performance on different physical function tests decreases with advancing age in Brazilian adults, following a gender-specific pattern. In none of the tests did the lowest mean values reach the cutoffs for sarcopenia. This suggests that region-specific cutoffs might be necessary to identify older people at risk of adverse events.

Gender differences in associating musculoskeletal complaints, housework, electronic device usage and physical exercise for administrative workers

Objectives. This study assessed musculoskeletal complaints (MSCs) in administrative workers, associating MSCs with non-paid housework, home use of electronic devices and physical exercise, while keeping a distinctive gender approach. This may promote the development of more effective preventive measures, by meeting the specific strengths and weaknesses of each gender. Methods. Ninety-six administrative workers (58 women and 38 men) who used computers more than 50% of their working time participated in a cross-sectional study. A questionnaire concerning individual socio-demographic data, habits and lifestyle, and including the Nordic musculoskeletal questionnaire (NMQ), was deployed. Gender-based odds ratios for MSCs in body areas over the previous 12 months and correlation coefficients between habits and lifestyle variables and NMQ variables were computed. Results. Women did not incur a higher risk of MSCs than men. Analysis of the association did not yield meaningful associations for either gender. Results suggest giving future consideration to development of gender-specific preventive measures. Conclusion. Computerized work performed concomitantly with physical exposures outside the workplace showed mixed associations with MSCs, according to gender and depending on the kind of exposure. Results are indicative of the need for development of gender-specific preventive measures.

Blue-collar work and women's health: A systematic review of the evidence from 1990 to 2015

Despite the implications of gender and sex differences for health risks associated with blue-collar work, adverse health outcomes among blue-collar workers has been most frequently studied among men. The present study provides a "state-of-the-field" systematic review of the empiric evidence published on blue-collar women's health. We systematically reviewed literature related to the health of blue-collar women published between January 1, 1990 and December 31, 2015. We limited our review to peer-reviewed studies published in the English language on the health or health behaviors of women who were presently working or had previously worked in a blue-collar job. Studies were eligible for inclusion regardless of the number, age, or geographic region of blue-collar women in the study sample. We retained 177 studies that considered a wide range of health outcomes in study populations from 40 different countries. Overall, these studies suggested inferior health among female blue-collar workers as compared with either blue-collar males or other women. However, we noted several methodological limitations in addition to heterogeneity in study context and design, which inhibited comparison of results across publications. Methodological limitations of the extant literature, alongside the rapidly changing nature of women in the workplace, motivate further study on the health of blue-collar women. Efforts to identify specific mechanisms by which blue-collar work predisposes women to adverse health may be particularly valuable in informing future workplace-based and policy-level interventions.

Emotional intelligence of medical students of Shiraz University of Medical Sciences cross sectional study

Emotional intelligence is the ability of an individual to assess and control emotions in oneself and others and also use this information in ongoing coping methods. Emotional intelligence is known to have an effect on the success rate of an individual as well as job performance and satisfaction. Though contradictory, emotional intelligence is supposed to have multiple factors affecting it. The aim of this study was to investigate whether Shiraz University of Medical Sciences has an effect on the emotional intelligence of its medical students and also whether the students' emotional intelligence had a relationship with their gender, hometown, and application exam rank or cumulative grade point average. Junior and senior medical students were approached from Autumn (2016) until winter 2017 and asked if they would fill out the Persian translation of TEIQue-SF questionnaire. They were also asked to inform us about their gender, educational region, cumulative grade point average, and Konkoor rank. The data was later analyzed by SPSS ver. 22. A significant difference was found between emotional intelligence of junior and senior medical students. No significant difference was found between emotional intelligence of male and female participants and there was no relation between emotional intelligence and Konkoor rank, cumulative grade point average, and educational region. The results showed that medical education has a negative effect the emotional intelligence. Males and females in this study had the same emotional intelligence that suggests the social effects on emotional intelligence. Also, the net effect of hometown and culture was not significant enough to influence emotional intelligence. As we analyzed the relationship of emotional intelligence and cumulative grade point average, it was concluded that the academic success of the students which is based on their scores is not related to their emotional intelligence.

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Emotional intelligence decreases in the course of medical education.

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Emotional intelligence has no difference between genders.

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Emotional intelligence is not related to grade point average or rank in the entry exam.

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Emotional intelligence is not related to hometown.

Impact of Work Organizational Factors on Carpal Tunnel Syndrome and Epicondylitis

OBJECTIVE

The aim of this study was to identify relationships between work organizational variables (job rotation, overtime work, having a second job, and work pacing) (These work organizational variables and their relationships with biomechanical and psychosocial exposures were studied previously and published in a separate paper.) and health outcome measures [carpal tunnel syndrome (CTS), lateral and medial epicondylitis (LEPI/MEPI)].

METHODS

Using a pooled baseline cohort of 1834 subjects, the relationships were studied using logistic regression models.

RESULTS

Varied degrees of associations between the work organizational and outcomes variables were found. Job rotation was significantly associated with being a CTS case [odds ratio (OR) = 1.23, 95% confidence interval (95% CI): 1.00 to 1.50]. Overtime work was significantly associated with lower LEPI prevalence (OR = 0.48, 95% CI: 0.28 to 0.84). No statistically significant associations were found between having a second job and different work pacing and any of the three health outcome measures.

CONCLUSIONS

Work organizational variables were only partially associated with the studied health outcomes.

Measuring Work Functioning: Validity of a Weighted Composite Work Functioning Approach

PURPOSE

To examine the construct validity of a weighted composite work functioning measurement approach.

METHODS

Workers (health-impaired/healthy) (n = 117) completed a composite measure survey that recorded four central work functioning aspects with existing scales: capacity to work, quality of work performance, quantity of work, and recovery from work. Previous derived weights reflecting the relative importance of these aspects of work functioning were used to calculate the composite weighted work functioning score of the workers. Work role functioning, productivity, and quality of life were used for validation. Correlations were calculated and norms applied to examine convergent and divergent construct validity. A t test was conducted and a norm applied to examine discriminative construct validity.

RESULTS

Overall the weighted composite work functioning measure demonstrated construct validity. As predicted, the weighted composite score correlated (p < .001) strongly (r > .60) with work role functioning and productivity (convergent construct validity), and moderately (.30 < r < .60) with physical quality of life and less strongly than work role functioning and productivity with mental quality of life (divergent validity). Further, the weighted composite measure detected that health-impaired workers show with a large effect size (Cohen's d > .80) significantly worse work functioning than healthy workers (discriminative validity).

CONCLUSION

The weighted composite work functioning measurement approach takes into account the relative importance of the different work functioning aspects and demonstrated good convergent, fair divergent, and good discriminative construct validity.

Developing a comprehensive approach to risk management of musculoskeletal disorders in non-nursing health care sector employees

This study of selected jobs in the health care sector explored a range of physical and psychosocial factors to identify those that most strongly predicted work-related musculoskeletal disorders (WMSD) risk. A self-report survey was used to collect data on physical and psychosocial risk factors from employees in three health care organisations in Victoria, Australia. Multivariate analyses demonstrated the importance of both psychosocial and physical hazards in predicting WMSD risk and provides evidence for risk management of WMSDs to incorporate a more comprehensive and integrated approach. Use of a risk management toolkit is recommended to address WMSD risk in the workplace.

First-time decisions regarding work injury annuity due to occupational disease: a gender perspective

OBJECTIVES

This study presents an investigation of first-time decisions regarding work injury annuity due to occupational disease. Focus is a number of potential underlying factors behind the gender gap, where women are disadvantaged, in the granting of work injury annuity.

METHODS

All 99 subjects (80 men and 19 women) who met the conditions of long-lasting reduction of work ability due to occupational disease (not occupational accident) in the Swedish Work Injury Insurance Act and were granted work injury annuity in 2010, together with a random sample of 118 subjects (55 men and 63 women) who were denied annuity in the same year, were selected for analysis. Each subject's case file from the Social Insurance Agency was examined with regards to cause of disease, diagnosis and the Social Insurance Agency's management and decision making of claims. The data were analysed by logistic regression analysis.

RESULTS

Men had a higher probability of being granted work injury annuity than women for musculoskeletal disorders (OR 4.16), mental disorders (OR 7.93) and diseases in other diagnostic chapters (OR 3.65). After adjustment for age, country of birth, diagnosis, work exposure factors and decision support factors, the higher probability for men of being granted work injury annuity remained (full model: OR 2.67, 95% CI 1.20 to 5.94).

CONCLUSIONS

Actions are necessary in order to establish equitable and gender-neutral treatment of work injury insurance claims. There is a need for more detailed knowledge of exposures in female-dominated jobs and the relationship between these exposures and occupational disease.

Perceived gender inequality in the couple relationship and musculoskeletal pain in middle-aged women and men

Aims: Musculoskeletal pain is a major health problem, especially in women, and is partially determined by psychosocial factors. The aim of the present study was to investigate whether gender inequality in the couple relationship was related to musculoskeletal pain. Methods: Participants ( n=721; 364 women and 357 men) were all individuals living in a couple relationship in the Northern Swedish Cohort, a 26-year Swedish cohort study. Self-administered questionnaire data at age 42 years comprised perceived gender inequality in the couple relationship and musculoskeletal pain (in three locations, summarised into one score and median-split), concurrent demographic factors, psychological distress, and previous musculoskeletal pain at age 30 years. Associations were examined using logistic regression. Results: Gender inequality was positively associated with symptoms of musculoskeletal pain in the total sample, remaining significant after addition of possible confounders and of previous musculoskeletal pain. Separate adjustment for concurrent psychological distress attenuated the association but not below significance. The association was present and of comparable strength in both women and men. Conclusions: Gender inequality in the couple relationship might contribute to the experience of musculoskeletal pain in both women and men. The results highlight the potential adverse bodily consequences of living in unequal relationships.

Effect of the rest interval duration between contractions on muscle fatigue

Background

We aimed to investigate the effect of rest interval, between successive contractions, on muscular fatigue.

Methods

Eighteen subjects performed elbow flexion and extension (30 repetitions) on an isokinetic dynamometer with 80º of range of motion. The flexion velocity was 120º/s, while for elbow extension we used 5 different velocities (30, 75, 120, 240, 360º/s), producing 5 different rest intervals (2.89, 1.28, 0.85, 0.57 and 0.54 s).

Results

We observed that when the rest interval was 2.89 s there was a reduction in fatigue. On the other hand, when the rest interval was 0.54 s the fatigue was increased.

Conclusions

When the resting time was lower (0.54 s) the decline of work in the flexor muscle group was higher compared with different rest interval duration.

Can the impact of gender equality on health be measured? A cross-sectional study comparing measures based on register data with individual survey-based data

Background

The aim of this study was to investigate potential associations between gender equality at work and self-rated health.

Methods

2861 employees in 21 companies were invited to participate in a survey. The mean response rate was 49.2%. The questionnaire contained 65 questions, mainly on gender equality and health. Two logistic regression analyses were conducted to assess associations between (i) self-rated health and a register-based company gender equality index (OGGI), and (ii) self-rated health and self-rated gender equality at work.

Results

Even though no association was found between the OGGI and health, women who rated their company as “completely equal” or “quite equal” had higher odds of reporting “good health” compared to women who perceived their company as “not equal” (OR = 2.8, 95% confidence interval = 1.4 – 5.5 and OR = 2.73, 95% CI = 1.6-4.6). Although not statistically significant, we observed the same trends in men. The results were adjusted for age, highest education level, income, full or part-time employment, and type of company based on the OGGI.

Conclusions

No association was found between gender equality in companies, measured by register-based index (OGGI), and health. However, perceived gender equality at work positively affected women’s self-rated health but not men’s. Further investigations are necessary to determine whether the results are fully credible given the contemporary health patterns and positions in the labour market of women and men or whether the results are driven by selection patterns.