Women's sexual and reproductive health in war and conflict: are we seeing the full picture?

It is well established that women's sexual and reproductive health (SRHR) is negatively affected by war. While global health research often emphasises infrastructure and systematic factors as key impediments to women's SRHR in war and postwar contexts, reports from different armed conflicts indicate that women's reproduction may be controlled both by state and other armed actors, limiting women's choices and access to maternal and reproductive health care even when these are available. In addition, it is important to examine and trace disparities in sexual reproductive health access and uptake within different types of wars, recognising gendered differences in war and postwar contexts. Adding feminist perspectives on war to global health research explanations of how war affects women's sexual and reproductive health might then contribute to further understanding the complexity of the different gendered effects war and armed conflicts have on women's sexual and reproductive health.

A Gender-Based and Quasi-Experimental Study of the Catastrophic and Impoverishing Health-Care Expenditures in Mexican Households with Elderly Members, 2000-2020

Latin America has experienced a rise in noncommunicable diseases (NCDs) which is having repercussions on the structuring of healthcare delivery and social protection for vulnerable populations. We examined catastrophic (CHE) and excessive (EHE, impoverishing and/or catastrophic) health care expenditures in Mexican households with and without elderly members (≥65 years), by gender of head of the households, during 2000-2020. We analyzed pooled cross-sectional data for 380,509 households from eleven rounds of the National Household Income and Expenditure Survey. Male- and female-headed households (MHHs and FHHs) were matched using propensity scores to control for gender bias in systematic differences regarding care-seeking (demand for healthcare) preferences. Adjusted probabilities of positive health expenditures, CHE and EHE were estimated using probit and two-stage probit models, respectively. Quintiles of EHE by state among FHHs with elderly members were also mapped. CHE and EHE were greater among FHHs than among MHHs (4.7% vs 3.9% and 5.5% vs 4.6%), and greater in FHHs with elderly members (5.8% vs 4.9% and 6.9% vs 5.8%). EHE in FHHs with elderly members varied geographically from 3.9% to 9.1%, being greater in less developed eastern, north-central and southeastern states. Compared with MHHs, FHHs face greater risks of CHE and EHE. This vulnerability is exacerbated in FHHs with elderly members, because of gender intersectional vulnerability. The present context, marked by a growing burden of NCDs and inequities amplified by COVID-19, makes key interlinkages across multiple Sustainable Development Goals (SDGs) apparent, and calls for urgent measures that strengthen social protection in health.

Spanish residents' experiences of care during the first wave of the COVID-19 syndemic: a photo-elicitation study

PURPOSE

The main aim of this research was to explore experiences of care during the lockdown of the first wave of COVID-19 syndemic in Spain.

METHODS

This is a qualitative and explorative study using self-photo-elicitation as a data collection method. Fifteen participants (Twelve women and three men) shared 25 photographs and one video between the June 18 and August, 2020. Participants' photographs and texts were collected online. Data were analysed based on Thematic Analysis.

RESULTS

Three emerging categories were constructed: 1) the deconstruction of care: self-care and collective care 2) the crisis of care and gendered care, 2) beyond anthropocentrism: animalism and ecology. Findings indicate the need to understand "care" in terms of social reproduction, including self-care, care towards other humans and non-human animals, and collective care. Also, the need to care for planetary health and to be in contact with nature as a form of self-care and social care.

CONCLUSIONS

Care in a period of social and health crisis puts human relationships and also non-human life at the centre. Care requires adopting taking an ecological one-health perspective.

Sex differences in antiplatelet therapy: state-of-the art

Antiplatelet therapy is a cornerstone of secondary prevention of cardiovascular diseases (CVDs). However, current guidelines are based on data derived primarily from men, as women are generally underrepresented in trials. Consequently, there are insufficient and inconsistent data on the effect of antiplatelet drugs in women. Sex differences were reported in platelet reactivity, patient management, and clinical outcomes after treatment with aspirin, P2Y₁₂ inhibitor, or dual antiplatelet therapy. To evaluate whether sex-specific antiplatelet therapy is needed, in this review we discuss (i) how sex affects platelet biology and response to antiplatelet agents, (ii) how sex and gender differences translate into clinical challenges and (iii) how the cardiological care in women might be improved. Finally, we highlight the challenges faced in clinical practice regarding the different needs and characteristics of female and male patients with CVD and address issues requiring further investigation.

Is self-advocacy universally achievable for patients? The experiences of Australian women with cardiac disease in pregnancy and postpartum

PURPOSE

Patient self-advocacy is valued and promoted; however, it may not be readily accessible to all. This analysis examines the experiences of women in Australia who had cardiac disease in pregnancy or the first year postpartum through the lenses of self-advocacy and gender, specifically seeking to elaborate on the contexts, impacts, barriers, and women's responses to the barriers to self-advocacy.

METHOD

A qualitative study design was used. Twenty-five women participated in semi-structured in-depth interviews. Data were analysed using thematic analysis.

RESULTS

Analysis of findings generated the following themes: 1) Silent dream scream, 2) Easier said than done, 3) Crazy-making, and 4) Concentric circles of advocacy. Regardless of women's personal attributes, knowledge and experience, self-advocating for their health was complex and difficult and had negative cardiac and psychological outcomes.

CONCLUSION

While the women encountered significant barriers to self-advocating, they were resilient and ultimately developed strategies to be heard and to advocate on their own behalf and that of other women. Findings can be used to identify ways to support women to self-advocate and to provide adequately resourced and culturally safe environments to enable healthcare professionals to provide person-centred care.

Breaking the silence around infertility: a scoping review of interventions addressing infertility-related gendered stigmatisation in low- and middle-income countries

Infertility is a reproductive health concern that deserves attention, as reconfirmed by the 2018 report of the Guttmacher-Lancet Commission on Sexual and Reproductive Health and Rights (SRHR). However, governments and SRHR organisations tend to neglect infertility. We conducted a scoping review of existing interventions aiming to decrease the stigmatisation of infertility in low- and middle-income countries (LMICs). The review consisted of a combination of research methods: academic database (Embase, Socological abstracts, google scholar; resulting in 15 articles), Google and social media searches, and primary data collection (18 key informant interviews and 3 focus group discussions). The results distinguish between infertility stigma interventions targeted at intrapersonal, interpersonal and structural levels of stigma. The review shows that published studies on interventions tackling infertility stigmatisation in LMICs are rare. Nevertheless, we found several interventions at intra- and interpersonal levels aiming to support women and men to cope with and mitigate infertility stigmatisation (e.g. counselling, telephone hotlines, and support groups). A limited number of interventions addressed stigmatisation at a structural level (e.g. empowering infertile women to become financially independent). The review suggests that infertility destigmatisation interventions need to be implemented across all levels. Interventions geared to individuals experiencing infertility should include women and men and also be offered beyond the clinical setting; and interventions should also aim to combat stigmatising attitudes of family or community members. At the structural level, interventions could aim to empower women, reshape masculinities and improve access to and quality of comprehensive fertility care. Interventions should be undertaken by policymakers, professionals, activists, and others working on infertility in LMICs, and accompanied with evaluation research to assess their effectiveness.

Just One Shot? The Contextual Effects of Matched and Unmatched Intoxication on Perceptions of Consent in Ambiguous Alcohol-fueled Sexual Encounters

The current research examined how contextual factors-the quantity of alcohol consumed by each partner, and whether this quantity matched-influenced how alcohol-fueled sexual encounters were perceived with regard to consent, coercion, sexual assault, and perceived responsibility of the focal partner for the outcome of the encounter. Across four studies (Ntotal = 535), participants read vignettes in which one person described a sexual encounter they had following a night out drinking. These scenarios differed within studies as a function of quantified alcohol consumed (1 shot; 15 shots) and whether both people in the vignettes consumed the same amount of alcohol (matched; unmatched). They also differed between studies as a function of whether the couples described were mixed gender or same gender. Across all four studies, scenarios in which both people in the scenario consumed different quantities of alcohol (i.e., 15 vs. 1 shot) were seen as less consensual, more coercive, and more likely to be an assault compared to scenarios where consumption was matched, especially at lower levels of intoxication (i.e., 1 shot each vs. 15 shots each). However, focal partners were also seen as less responsible for the outcome of the interaction when levels of intoxication were unmatched compared to matched. This pattern replicated across scenarios depicting same-gender and mixed-gender couples. These findings suggest that people prioritize information regarding whether sexual partners are "matched" or "unmatched" in terms of their intoxication when evaluating whether ambiguous sexual encounters are consensual and perceived individual responsibility.

The Role of Sexting on the Perception of Image-Based Sexual Abuse

Gender-based violence is a widespread phenomenon that significantly impacts many women around the world. Among the different forms that it might take, image-based sexual abuse represents one of the most common forms nowadays. According to the literature, sexting-the sharing of sexually explicit messages or images-is one of the most important risk factors for image-based sexual abuse because sexts can be forwarded or published without the authorization of the originator. Nevertheless, sexting can play a role in sexual and relational development and serve as a first step in experimenting with sexual contact in real life. In this study (N = 603 from the general population), we examined the relations between people's beliefs about sexting, attitudes toward it, and sexting behavior on the one hand, and reactions to a situation of nonconsensual dissemination of sexts on the other hand. Results showed that social pressure exerted by peers and partners to sext was associated with both positive attitudes toward sexting and sexting behaviors. Attitudes toward sexting, then, have a spillover effect on the reactions toward a victim of nonconsensual dissemination of sexts, in terms of empathy, victim blaming, and affective reactions. Implications for both research and policymaking regarding this form of gender-based violence are discussed.

Manifestations and Reinforcement of Heteronormativity in the Workplace: A Systematic Scoping Review

This scoping review systematizes the evidence available to date on the manifestations of heteronormativity in the workplace. The reviewed literature shows that, at an organizational level, heteronormativity is reproduced in the configuration of space, organizational policies, and the monitoring of their accomplishment by leaders. At an interpersonal level, employees interact with others based on heterosexual presumptions, they reward what is aligned with heteronormativity, and censor what is not. Finally, individuals acting of their own volition may perform their gender in ways that strengthen the presumption of heterosexuality and communicate heteronormativity alignment. This review offers suggestions for future research in the field of heteronormativity in the workplace and includes theoretical and practical implications for the creation of inclusive organizations.

Disasters and the diminishing of women's economic empowerment

This paper examines, both theoretically and empirically, the relationship between rapid-onset disasters and women's economic freedom. Rapid-onset disasters create difficulties for all involved, but without proper discussion of and changes to women's economic status in society, they will continue to suffer disproportionately. The study answers the following question: 'how do disasters impact women's economic empowerment?'. It argues that there are underlying factors contributing to unequal economic opportunities that are exacerbated by disasters. Current literature discusses how disasters affect women's economic and political rights, but often it does not account for variables that may not have been captured in contemporary indices. The paper assesses women's burden of care, restrictions on mobility, formal economic employment, and access to recovery resources with respect to their economic empowerment. And it analyses 180 countries and territories that experienced disasters between 1981 and 2019 to uncover their effects on women's economic freedom. This research could facilitate and help to alter the overall narrative on women's empowerment.

Self-interestedness in Research Collaboration and its Association with Career Stage and Nature of Collaboration: A Survey of Zimbabwean Researchers

During collaboration in research, it may happen that some researchers become involved in behaviours that reflect so-called 'self-interestedness', which means that they pursue their personal interest or benefit without considering others. This study examined how researchers in Zimbabwe perceive instances of self-interestedness among research collaborators, and how these perceptions differ according to their career stage and the nature of collaboration. An online survey of researchers in Zimbabwe was conducted to gather information about six instances of self-interestedness among research collaborators. The results show that Zimbabwean researchers involved exclusively in national collaboration reported greater degrees of collaborator self-interestedness than Zimbabwean researchers involved in international collaboration. However, early-career researchers and established researchers did not differ significantly regarding their experiences of collaborator self-interestedness. Measures aimed at capacitating research organisations and research teams in developing countries in the African context, to counter collaborator self-interestedness, are recommended.

Intersecting effects of sex/gender and autism on structural language: A scoping review

LAY ABSTRACT

Research about autism is mostly about boys and men, even though many autistic people are girls, women, and transgender/nonbinary. We wanted to learn more about how gender interacts with language skills in autistic people, so we reviewed existing research articles on this topic. We also wanted to know how this previous research talked about gender. Included articles had to measure language skills for autistic people of different genders. They also had to be published between 2000 and 2021. Twenty-four articles met these requirements. We found that autistic girls showed better language skills than autistic boys but worse skills than nonautistic girls. This may be one reason that autistic girls are underdiagnosed compared to autistic boys. If we compare autistic girls to nonautistic girls instead, we can see more language differences and possible areas to target in interventions. This study supports the need to create diagnostic and support measures for autism that take gender into account. Also, only one article mentioned autistic people who are transgender or nonbinary. Researchers who want to learn more about gender and autism need to understand gender diversity and recognize that many autistic people are transgender or nonbinary.

Teachers' Verbal and Nonverbal Communication, Students' Psychological Needs, and Positive and Negative Outcomes in Physical Education

Focused on physical education (PE), this study examined the association between teachers' communication and students' psychological needs, enjoyment/boredom, PE usefulness, and students' grade perception. Participants were 1,000 students (572 girls; Mage = 14.58 ± 0.65) from 29 Spanish secondary schools. A path model including variables measured at three times was tested: teachers' verbal/nonverbal communication (Time 1), needs satisfaction/frustration (Time 2), and PE outcomes (Time 3). Verbal communication positively predicted needs satisfaction, which, in turn, positively predicted enjoyment, PE usefulness, and students' grade perception and negatively predicted boredom. Verbal communication negatively predicted needs frustration, which was a positive predictor of boredom. Multigroup analysis showed that gender did not moderate the associations in the path model, whereas mediating effects were found between teachers' communication and consequences via students' psychological needs. Teachers should improve their communicative capacities to satisfy students' psychological needs and promote positive PE  outcomes.

"Bridging the Gap": School Nurse Experiences Providing Care for Transgender and Gender Diverse Students and Their Parents/Guardians

School systems are often not set up to support transgender and gender diverse (TGD) students, which results in unsafe and unsupportive environments and other institutional barriers to helping TGD students thrive. An important factor to students' feeling safe and supported in schools may be their relationship with school nurses. The purpose of this study was to describe school nurses' experiences working with TGD students and their parents/guardians, their role in working with this community, and the challenges nurses face when trying to serve TGD students. Semistructured interviews were conducted with 23 school nurses across a Midwestern state. Thematic analysis was used to identify themes: gender-affirming education and interpersonal collaboration, bridging the gap between TGD youth and parents/guardians, gender-affirming care and confidentiality, and navigating parental acceptance and gender-affirmation. School nurses expressed a strong desire to support TGD students but lack the structure and training within schools.

Gender Authorship Trends Among Craniofacial Publications: A 20-Year Analysis

This study aims to identify gender disparities within the subspecialty of craniofacial surgery as women surgeons remain underrepresented in academia and leadership, arenas heavily dictated by research productivity.

All craniofacial articles published in 3 major research journals from 2000 to 2020 were reviewed and evaluated in 5-year increments.

Information regarding author gender, authorship distribution, geographic origin, and publication type was collected. ANOVA, χ2, and logistic regression modeling were used for analysis.

In total, there were 3684 articles with 15 206 total authors-3128 (20.6%) were women, including 665 (21.3%) first authors, 1980 (63.2%) middle authors, and 487 (15.7%) senior authors. Mean women authorship increased significantly from 2000 to 2020 (0.33 vs 1.22 P < .001) with corresponding significant increases in first and senior authorship (8.63% vs 27.02; 5.65% vs 16.13%; P < .001). Statistically significant trends across time were observed for first and senior authorships (P < .001). Women were more likely to publish original publications as first and senior authors (OR: 1.83, P < .001; OR: 1.37, P = .0012). Women were less likely to publish editorial articles (OR 0.6, P < .001). The United States ranked third in publication output by female first authors but was behind all regions except Africa for output by female senior authors.

Although female authorship has increased significantly over the last 2 decades, women remain a minority within the craniofacial literature. Further research is needed to elicit the root of these disparities.

Experiences of Street Harassment and the Active Engagement of Bystanders: Insights From a Swiss Sample of Respondents

In this article, we analyze data from a survey conducted in the Swiss city of Fribourg to investigate the correlation between bystanders' experiences of street harassment and their likelihood of active engagement and strategies used to stop the harasser or assist and support targets of street harassment. Results reveal that, among bystanders, lifetime experiences of street harassment correlate positively with their ability to recognize street harassment conduct and the likelihood of intervention, support of the survivors, and reporting emergencies, even more significantly when the bystander endured physical abuse. In addition, behavioral differences among bystanders reflect different forms of resistance to the sexist culture that fuels street harassment. In light of these findings, we emphasize the need to integrate the narratives of the bystanders into awareness programs and campaigns, the importance of designing tools and policies to improve feelings of safety and limit street harassment conducts, including forms of benevolent sexism, and support further studies to assess the effectiveness of different intervention strategies in support of victims, including the need to research the use of digital media and its impact as a deterrent to street harassment or in increasing police reporting.

Gender and Language in Letters of Recommendation for Obstetrics and Gynecology Fellowship Applications

OBJECTIVE

To delineate the use of gender-biased language in letters of recommendation for Obstetrics and Gynecology fellowships and its impact on applicants.

DESIGN

Fellowship letters of recommendation from 4 Obstetrics and Gynecology specialties at a single institution in 2020 were included.

PRIMARY OUTCOME

frequency of agentic and communal language in letters of recommendation using Linguistics Inquiry Word Count software.

SECONDARY OUTCOMES

letter of recommendation length and language utilization by author gender and applicant success measured by interviews and match success. Marginal models were fit to determine if language varied by applicant and writer gender and subspecialty. Modified Poisson regression models were used to determine associations between language and interview receipt.

SETTING

Single academic institution (Duke University); 2020 OB/GYN fellowship application cycle.

PARTICIPANTS

A total of 1216 letters of recommendation submitted by 326 unique applicants for OB/GYN subspecialty fellowships at our institution.

RESULTS

Rates of gender-biased language were low (Agentic:1.3%; communal: 0.8%). Agentic term use did not vary by applicant or author gender (p = 0.78 and 0.16) Male authors utilized 19% fewer communal terms than females (p < 0.001). Each 0.25% increase in agentic language was associated with an 18% reduction in the probability of interview invitation at our institution (p = 0.004). Percentage of agentic or communal language was not associated with successful matching into any subspecialty.

CONCLUSIONS

No differences in agentic vs communal language based on applicant gender were found in this cohort, though female letter writers wrote longer letters with more communal terms. Increasing agentic terms negatively impacted interview invitation but did not affect successful matching.

Inequalities in the Evaluation of Male Versus Female Athletes in Sports Medicine Research: A Systematic Review

BACKGROUND

Female sports participation continues to rise; however, inequalities between male and female athletes still exist in many areas and may extend into medical research.

PURPOSE

The purpose of this study was to (1) compare the number of published studies evaluating male versus female athletes in various sports and (2) identify which co-ed sports currently underrepresent female athletes in the sports medicine literature.

STUDY DESIGN

Systematic review; Level of evidence, 4.

METHODS

All nonreview research studies published from 2017 to 2021 in 6 top sports medicine journals were considered for inclusion. Sports medicine studies were included that isolated athletes, reported study outcomes specific to male and/or female patients, provided study outcomes for specific sports, and evaluated ≤3 different sports. The total number of studies reporting on male and/or female athletes were compared for all sports, and odds ratios (ORs) were calculated. Comparisons of study design, level of sports participation, outcomes assessed, and study quality were also made according to participant sex.

RESULTS

Overall, 669 studies were included the systematic review. Most studies isolated male athletes (70.7%), while 8.8% isolated female athletes and 20.5% included male and female athletes. Female athletes were more frequently studied in softball and volleyball, while male athletes were more commonly researched in baseball, soccer, American football, basketball, rugby, hockey, and Australian football. Notably, male athletes were largely favored in baseball/softball (91% vs 5%; OR = 18.2), rugby (72% vs 5%; OR = 14.4), soccer (65% vs 15%; OR = 4.3), and basketball (58% vs 18%; OR = 3.2).

CONCLUSION

Sports medicine research has favored the evaluation of male athletes in most sports, including the majority of co-ed sports. Potential reasons for this inequality of research evaluation include availability of public data and database data, financial and promotional incentives, a high percentage of male sports medicine clinicians and researchers, and sex biases in sport. While the causes of these differences are multifaceted, researchers should consider both sexes for study inclusion whenever possible, and journals should support a more balanced representation of research publications regarding male and female athletes.

Digitizing nursing: A theoretical and holistic exploration to understand the adoption and use of digital technologies by nurses

BACKGROUND

With healthcare undergoing rapid digitalization, the effective integration of new technologies is crucial for nursing professionals, who form the largest group in the healthcare workforce. However, barriers within the nursing profession may impede digitalization efforts, leading to under utilization of available technologies and missed opportunities for enhancing healthcare quality and population health.

AIMS

This article aims to investigate the adoption and use of digital technologies by nurses, considering how key demographics, such as gender, age, and voluntariness of technology use, interact to influence their acceptance and utilization of these technologies.

METHODS

Employing the Unified Theory of Acceptance and Use of Technology (UTAUT) as a framework, we conducted a discursive exploration, supplemented by a literature review from diverse academic sources. Keywords related to UTAUT, digitalization, nursing practice and technology adoption were searched on PubMed, CINAHL and Google Scholar. Additionally, UK government and professional regulator reports were examined to understand current recommendations concerning digital technologies in nursing practice and the profession's demography. Searches focused on moderating factor domains, and the last search was conducted on 26 April 2023.

RESULTS

The study revealed that the successful implementation of digital technologies in nursing practice requires a nuanced understanding of the nursing workforce's characteristics and preferences. Gender, age and voluntariness of technology use were found to intersect and influence nurses' acceptance and utilization of digital tools.

DISCUSSION

By applying UTAUT in the context of nursing, this study highlights the importance of tailored implementation strategies for digital technologies. A technologically deterministic perspective is insufficient; instead, consideration of social factors specific to nursing is essential for successful adoption.

CONCLUSION

To maximize the benefits of digitalization in healthcare, it is imperative to address the barriers faced by nursing professionals. A comprehensive understanding of how key demographics impact technology adoption will inform targeted strategies, enhancing the engagement of nurses with digital tools and fostering innovation in healthcare practices. Further research and primary data are needed, but this study lays the foundation for future advancements in digital healthcare integration for nursing professionals.

RELEVANCE TO CLINICAL PRACTICE

The issues highlighted in this article are relevant to nurse leaders and those responsible for implementing technologies within nursing contexts. They are also relevant to technology developers who may benefit from considering the evidence associated with the moderating demographic factors highlighted in this article. Without a holistic approach to the implementation of technology, challenges associated with the use of digital technology by nurses are likely to persist. By considering the moderating demographic factors highlighted within the UTAUT (age, gender, voluntariness of use and experience) nurse leaders and technology developers may have greater success obtaining greater clinical outcomes from digital technology. This work was completed in 2022.

NO PATIENT OR PUBLIC CONTRIBUTION

Due to the focus of this article being one on professional challenges within the nursing profession, no involvement from patients or the public was sought.

The role of intellectual disability and emotional regulation in the autism-depression relationship

LAY ABSTRACT

Many people with autism and intellectual disability have significant levels of depressive symptoms. However, this relationship is not clear. For this reason, knowing the factors that are associated with having depression in autism and intellectual disability is important. Emotion regulation is associated with depression in autism spectrum disorder and intellectual disability. After evaluating a group of people with autism and intellectual disability, we found that people with mild intellectual disability have problems regulating their emotions which lead them to develop depressive symptoms. These findings suggest that interventions designed to prevent or reduce depressive symptoms in people with autism spectrum disorder and mild intellectual disability should include among their goals emotional regulation.

"Older, Faster, Stronger": The Multiple Benefits of Masters Sport Participation

While masters sport aligns with the holistic concept of active aging, related research has focused predominantly on the physical domain, and less is known about the psychological, cognitive, and social benefits of older adults' participation. This study examined, in combination, the perceived psychological, social, cognitive, and physical benefits of training and competing as a masters athlete, while considering age and gender differences. Forty masters athletes residing in Canada were interviewed (21 men and 19 women; 15 who were 50-64 years and 25 who were 65-79 years), representing 15 different sports. Interviews were coded both deductively and inductively, revealing several subthemes of benefits for the broader perceived psychological, social, cognitive, and physical benefits, with few but notable differences between women and men, and those younger than 65 years and those 65+ years. Our findings provide new insights into the positive experiences of active aging associated with high levels of physical activity among older adults, such as greater self-confidence, especially for women, comradery, and feeling mentally sharper, especially for the older age group.

Effect of the age and sex on growth performance and feather quality of 13 to 25-weeks-old White Roman geese

This study aimed to determine the effect of age and sex in weeks on growth, carcass performances, and feather quality of White Roman geese and analyze the relative effect of age and sex in weeks on feather characteristics in geese. In animal experiments, 120 White Roman geese aged 13 wk were randomly distributed among 12 pens and fed grower diet ad libitum during the growing period, with each pen containing 10 males or 10 females, depending on a completely random design. Ten geese each in their 13, 15, 17, 19, 21, 23, and 25 wk of age were sacrificed. The results showed that the age had no significant effect on the body weight (BW) of geese (P > 0.05). The chest girth was significantly longer in 21 to 25 wk old than in 13- to 19-wk-old geese (P < 0.05). The results reveal no significant change in carcass weight of grower geese among 13- to 25-wk age groups (P > 0.05). The down percentage of the 25-wk-old age group was significantly higher than that of the 13-, 15-, and 17-wk age groups (P < 0.05). The male geese had a higher dry feather weight than the females (P < 0.05). Similarly, the 18-h feed-deprived body weight (18-h FDBW) and 4 to 10 cm feather weight were significantly negatively correlated in grower geese (-0.42). This provides the feather industry an opportunity for the better utilization of grower geese by-products. In conclusion, the age has no influence on BW among 13- to 25-wk-old geese, and a good down percentage and dry weight were observed at 25 wk of age. The 18-h FDBW and down percentage had a significantly negative correlation (-0.55) in grower geese.

Racial and Ethnic Differences in Sleep Duration Life Expectancies among Men and Women in Mid-to-Late Life

This analysis documents U.S. racial/ethnic and gender differences in life expectancies with different self-reported sleep durations among adults aged 50 and older. We used self-reported sleep duration and linked mortality information from the 2004-2015 National Health Interview Survey (n = 145,015) to calculate Sullivan Method Lifetables for life expectancies with different self-reported sleep duration states: short (≤6 hours), optimal (seven to 8 hours), and long (≥9 hours) sleep duration per-day by race/ethnicity and gender. Non-Hispanic Black men (35.8%, 95% CI: 34.8%-36.8%) and women (36.5%, 95% CI: 35.7%-37.1%) exhibited the highest proportion of years lived with short sleep duration followed by Hispanic men (31.1%, 95% CI: 29.9%-32.3%) and women (34.1%, 95% CI: 33.1%-35.1%) and Non-Hispanic White men (25.8%, 95% CI: 25.4%-26.2%) and women (27.4%, 95% CI: 27.0%-27.7%). These results highlight how race/ethnic inequality in sleep duration and life expectancy are intertwined among older adults in the U.S.

Looking beyond workforce parity: addressing gender inequity in pathology

While women pathologists have made up over one-third of pathologists in the Australian workforce for over 15 years and at least 50% since 2019, they are under-represented in senior leadership roles, scientific publications, grant recipients, editorial boards, key presentations, and professional awards. This is not unique to pathology and is seen in the broader medical and academic community. Barriers to gender equity and equality in pathology, medicine and academia include gender stereotypes, gender-based discrimination, structural and organisational barriers as well as broader social and cultural barriers. A diverse leadership reflective of the whole professional body and the broader community is important for optimal health outcomes. It is the responsibility and moral duty of individuals and organisations to address any gender disparities, inequities, and inequalities by monitoring, identifying, and acting on gender biases and systemic barriers that hinder appropriate levels of representation by women.

Beyond the Binary: Moving the Radiology Workforce Toward Gender Inclusion, From the AJR Special Series on DEI

Gender representation in radiology has traditionally been evaluated and reported through binary models, accompanied by advocacy efforts focused on increasing the number of women in radiology. A paucity of data exists to understand the entire gender composition of the radiology workforce, including representation of people who are transgender and gender diverse. Further, little information exists on how to provide a supportive work environment for radiologists and support staff who identify as belonging to an underrepresented gender minority group. Intentional efforts to comprehensively understand the gender representation of the radiology workforce can help to establish a diverse workforce that is more representative of the patient populations that we serve, while promoting high-quality inclusive health care. Moving beyond gender binary thought and practices can help foster a culture of inclusion and belonging in radiology. This article provides practical steps that radiology practices can take to understand and support gender diversity beyond the binary in the radiology workforce, including providing definitions and inclusive language, understanding limitations of historical methods of gender data collection in radiology and relevant published literature, establishing best practices for future data collection, and developing a strategic vision with action items to create a more inclusive work environment.

Intersectionality of Race, Ethnicity, and Gender in the Otolaryngology Match From 2013 to 2019

OBJECTIVES

Racial, ethnic, and gender disparities in the otolaryngology-head and neck surgery (OHNS) match have been described individually, but not intersectionally. Intersectionality recognizes how multiple forms of discrimination (e.g., sexism, racism) can have a combined effect. The objective of this study was to analyze racial, ethnic, and gender disparities in the OHNS match using an intersectional approach.

METHODS

Cross-sectional evaluation of data from otolaryngology applicants from the Electronic Residency Application Service (ERAS) and of corresponding otolaryngology residents from the Accreditation Council for Graduate Medical Education (ACGME) from 2013 to 2019. Data were stratified by race, ethnicity, and gender. The Cochran-Armitage tests assessed trends over time in the proportions of applicants and corresponding residents. Chi-square tests with Yates' continuity correction were performed to evaluate differences between the aggregate proportions of applicants and corresponding residents.

RESULTS

The proportion of White men in the resident pool was increased compared to the applicant pool (ACGME 0.417, ERAS 0.375; Δ + 0.042; 95% CI 0.012 to 0.071; p = 0.03). This was also the case for White women (ACGME 0.206, ERAS 0.175; Δ + 0.031; 95% CI 0.007 to 0.055; p = 0.05). In contrast, there was a smaller proportion of residents compared to applicants among Multiracial men (ACGME 0.014, ERAS 0.047; Δ - 0.033; 95% CI -0.043 to -0.023; p < 0.001) and Multiracial women (ACGME 0.010, ERAS 0.026; Δ - 0.016; 95% CI -0.024 to -0.008; p < 0.001).

CONCLUSION

The findings of this study imply that White men have a persistent advantage, while several racial, ethnic, and gender minorities are disadvantaged in the OHNS match. Further research is necessary to examine why these differences exist in residency selection, including evaluation during the screening, reviewing, interviewing, and ranking stages. Laryngoscope, 133:2558-2563, 2023.

Development and Validation of a Nomogram to Predict the Risk of Tinnitus Severity in Patients With Unilateral Subjective Tinnitus

Purpose: To develop and validate a nomogram for predicting the risk of tinnitus severity in patients with unilateral subjective tinnitus. Methods: The objective of this study was to establish and validate a nomogram specifically designed for patients with unilateral subjective tinnitus. We collected data on unilateral subjective tinnitus from the Air Force Medical Center, including 146 participants between January 2021 and June 2022. Risk factors for unilateral subjective tinnitus severity were evaluated by least absolute shrinkage and selection operator (LASSO) and binary logistic regression analysis. Internal verification was used to evaluate the performance of the nomogram. The discriminative ability was measured by the consistency index (C-indices) and the area under the curve (AUC) of the receiver operating characteristic (ROC) curves. Results: All included patients were randomized according to a 7:3 ratio into the training cohort (104 patients) and the validation cohort (42 patients). The LASSO regression model identified sex, tinnitus loudness, and hearing loss as candidate variables. Binary logistic regression analysis showed that gender (OR: 0.76; 95% CI: 0.6-0.95; P = 0.021) and tinnitus loudness (OR: 1.37; 95% CI: 1.09-1.72; P = 0.009) were significant predictors of unilateral subjective tinnitus severity, while age, tinnitus matching frequency, and tinnitus duration were not. The significant predictors were included in the nomogram. Hearing loss was included in the nomogram based on prior clinical experience and previous studies. The training and validation cohorts C-indexes were 0.707 (95% CI: 0.607-0.806) and 0.706 (95% CI: 0.548-0.863), respectively. The training and validation cohort's AUC of the ROC curves were 0.692 and 0.705, respectively. Conclusion: We have developed and validated a nomogram based on gender, hearing loss, and tinnitus loudness, which can effectively predict the risk of tinnitus severity in patients with unilateral subjective tinnitus. The nomogram provides personalized prediction results for patients with unilateral subjective tinnitus, which is beneficial for clinical decision-making and treatment plan development.

Characterizing gender trends in head and neck fellowship graduates from 2008 to 2018

OBJECTIVES

Evaluation of potential gender gaps among Head and Neck (H&N) surgeons can highlight areas for increased support of female H&N surgeons and improve gender diversity within the subspecialty. To evaluate gender trends in representation and career trajectory among recent H&N surgery fellowship graduates.

METHODS

This cross-sectional analysis included graduates from Head and Neck Surgery fellowships accredited by the American Head and Neck Society (AHNS) from 2008 to 2018. Additional demographic data was collected via publicly available websites including gender, years in practice, practice location, type of practice, h-index, and academic rank. The primary outcomes were the proportion of female Head and Neck fellowship graduates and gender trends in career trajectory and academic productivity (via h-index).

RESULTS

Between 2008 and 2018, 449 surgeons graduated from Head and Neck surgery fellowship with females comprising 99 of 449 graduates (22%). Female representation increased from 1 of 30 (3%) graduates in 2008 to 17 of 52 (33%) in 2018. A proportionally similar number of women graduating fellowship also practiced in an academic setting (23%). There were fewer female assistant, associate and full professors compared with their male counterparts. Women had lower h-indices compared with men even when controlling for years in practice (mean 11.4 vs. 8.2, p < 0.03).

CONCLUSION

Despite the increase in women graduating from H&N surgery fellowships, gender disparities within academic rank and academic productivity as measured by h-index remain. While a proportional number of women completing fellowship are entering academic practice, additional investigation and support is needed to address the potential gender gaps identified within academic H&N surgery.

Burden of mental disorders by gender in Pakistan: analysis of Global Burden of Disease Study data for 1990-2019

AIMS AND METHOD

We aimed to examine the burden of mental disorders in Pakistan over the past three decades. We used the crude data of disability-adjusted life-years (DALYs) obtained from the Global Burden of Disease Study database (1990-2019) to represent burden. Data were retrieved on 26 January 2021. Data for adults of reproductive age (aged 15-49 years) were analysed to discuss and interpret the disease burden. An analysis was conducted on total DALYs separately for the genders for ten mental disorders reported in Pakistan.

RESULTS

DALYs increased drastically with the onset of reproductive age. Depressive disorder was the most reported mental disorder, contributing 3.13% (95% CI 2.25-4.24) of total DALYs, and varied significantly between genders: females 3.89% (95% CI 2.73-5.29) versus males 2.37% (95% CI 1.62-3.25).

CLINICAL IMPLICATIONS

A nationwide high-quality epidemiological surveillance system should be implemented to monitor mental disorders and offer culturally appropriate preventive services.