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International Journal of Health Policy... Aug 2022Human resources are at the heart of health systems, playing a central role in their functionality globally. It is estimated that up to 70% of the health workforce are...
BACKGROUND
Human resources are at the heart of health systems, playing a central role in their functionality globally. It is estimated that up to 70% of the health workforce are women, however, this pattern is not reflected in the leadership of health systems where women are under-represented.
METHODS
This systematized review explored the existing literature around women's progress towards leadership in the health sector in low- and middle-income countries (LMICs) which has used intersectional analysis.
RESULTS
While there are studies that have looked at the inequities and barriers women face in progressing towards leadership positions in health systems within LMICs, none explicitly used an intersectionality framework in their approach. These studies did nevertheless show recurring barriers to health systems leadership created at the intersection of gender and social identities such as professional cadre, race/ethnicity, financial status, and culture. These barriers limit women's access to resources that improve career development, including mentorship and sponsorship opportunities, reduce value, recognition and respect at work for women, and increase the likelihood of women to take on dual burdens of professional work and childcare and domestic work, and, create biased views about effectiveness of men and women's leadership styles. An intersectional lens helps to better understand how gender intersects with other social identities which results in upholding these persisting barriers to career progression and leadership.
CONCLUSION
As efforts to reduce gender inequity in health systems are gaining momentum, it is important to look beyond gender and take into account other intersecting social identities that create unique positionalities of privilege and/or disadvantage. This approach should be adopted across a diverse range of health systems programs and policies in an effort to strengthen gender equity in health and specifically human resources for health (HRH), and improve health system governance, functioning and outcomes.
Topics: Female; Humans; Developing Countries; Gender Identity; Health Workforce; Intersectional Framework; Leadership
PubMed: 33619934
DOI: 10.34172/ijhpm.2021.06 -
AIDS and Behavior Sep 2021The preponderance of HIV interventions have been behavioral, targeting individual, dyadic, or group dynamics. However, structural-level interventions are required to... (Review)
Review
The preponderance of HIV interventions have been behavioral, targeting individual, dyadic, or group dynamics. However, structural-level interventions are required to decrease HIV transmission and increase engagement in care, especially for men who have sex with men (MSM), particularly Black and Latinx MSM. A systematic literature review was conducted to assess the current state of structural interventions; only two studies detailing structural interventions related to HIV for Black and Latinx MSM in the US were identified. An additional 91 studies which discussed structural-level barriers to optimal HIV outcomes among MSM, yet which did not directly evaluate a structural intervention, were also identified. While this paucity of findings was discouraging, it was not unexpected. Results of the systematic review were used to inform guidelines for the implementation and evaluation of structural interventions to address HIV among MSM in the U.S. These include deploying specific interventions for multiply marginalized individuals, prioritizing the deconstruction of structural stigma, and expanding the capacity of researchers to evaluate "natural" policy-level structural interventions through a standardization of methods for rapid evaluative response, and through universal application of sex, sexual orientation, and gender identity demographic measures.
Topics: Female; Gender Identity; HIV Infections; Homosexuality, Male; Humans; Male; Sexual and Gender Minorities; Social Stigma
PubMed: 33534056
DOI: 10.1007/s10461-021-03167-2 -
Sexual and Reproductive Health Matters 2021Self-administration of quality gender-affirming hormones is one approach to expanding access to hormone therapy for individuals seeking secondary sex characteristics... (Review)
Review
Self-administration of quality gender-affirming hormones is one approach to expanding access to hormone therapy for individuals seeking secondary sex characteristics more aligned with their gender identity or expression and can be empowering when provided within safe, supportive health systems. To inform World Health Organization guidelines on self-care interventions, we systematically reviewed the evidence for self-administration compared to health worker-administration of gender-affirming hormones. We conducted a comprehensive search for peer-reviewed articles and conference abstracts that addressed effectiveness, values and preferences, and cost considerations. Data were extracted in duplicate using standardised forms. Of 3792 unique references, five values and preferences articles were included; no studies met the criteria for the effectiveness or cost reviews. All values and preferences studies focused on self-administration of unprescribed hormones, not prescribed hormones within a supportive health system. Four studies from the U.S. ( = 2), Brazil ( = 1), and the U.K. ( = 1) found that individuals seeking gender-affirming hormone therapy may self-manage due to challenges finding knowledgeable and non-stigmatising health workers, lack of access to appropriate services, exclusion, and discomfort with health workers, cost, and desire for a faster transition. One study from Thailand found health worker perspectives were shaped by restrictive legislation, few transgender-specific services or guidelines, inappropriate communication with health workers, and medical knowledge gaps. There is limited literature on self-administration of gender-affirming hormone therapy. Principles of gender equality and human rights in the delivery of quality gender-affirming hormones are critical to expand access to this important intervention and reduce discrimination based on gender identity.
Topics: Cost-Benefit Analysis; Female; Gender Identity; Hormones; Humans; Male; Transgender Persons; Transsexualism
PubMed: 35312467
DOI: 10.1080/26410397.2022.2045066 -
International Journal For Equity in... Oct 2020Gender as a social construct contributes to determine who migrates and which migration-related risks and opportunities emerge in all phases of the migration trajectory....
BACKGROUND
Gender as a social construct contributes to determine who migrates and which migration-related risks and opportunities emerge in all phases of the migration trajectory. Simultaneously, migration influences the individual as well as societal definition and perception of gender roles. An explicit gender perspective in migration-related epidemiological research can contribute to adequately analyse and interpret the health of migrants. This systematic review gives a comprehensive overview on how gender has been conceptualised, operationalised and measured in social epidemiologic studies aiming to assess the influence of gender on health among migrants.
METHODS
We searched PubMed, Embase, CINAHL, the Cochrane Library, EconLit and PsycINFO and conducted backward reference searching. Reviewers independently selected studies, extracted data and conducted the quality assessment. Eligible studies actively aimed to understand, identify or explain the influence of gender on migrants' health, whereby the role of gender can encompass a variety of mechanisms, processes or states of differentiation, discrimination and/or inequality.
RESULTS
Almost all of the 43 studies were cross-sectional and focussed on health outcomes in the post-migration phase. The most common theme of research was the health of male migrants in the US, and in particular of men who have sex with men (MSM). All studies treated gender as a binary variable (men vs. women), without discussing additional types of gender identities. A minority of studies differentiated clearly between sex and gender. Gender was mostly operationalised through attitudes toward gender roles and gender-based discrimination, experienced at the individual level. Community and societal level gender measures capturing structural gender determinants were underrepresented.
CONCLUSIONS
The intersections of migration and gender suggested synergistic effects on health that only become visible when considering those two social determinants together. Future research needs to embrace a multilevel and non-binary understanding of gender and reflect on the influence of gender in the different phases of the migration journey.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42019124698 .
Topics: Cross-Sectional Studies; Epidemiology; Female; Gender Identity; Health Status; Humans; Male; Transients and Migrants
PubMed: 33054755
DOI: 10.1186/s12939-020-01289-y -
Translational Behavioral Medicine Oct 2020Stigma against sexual and gender minorities is a major driver of health disparities. Psychological and behavioral interventions that do not address the stigma...
Stigma against sexual and gender minorities is a major driver of health disparities. Psychological and behavioral interventions that do not address the stigma experienced by sexual and gender minorities may be less efficacious. We conducted a systematic review of existing psychological and behavioral health interventions for sexual and gender minorities to investigate how interventions target sexual and gender minority stigma and consider how stigma could affect intervention efficacy. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed. Eligible studies were peer reviewed and published in English between January 2003 and July 2019 and reported empirical results of behavioral or psychological interventions implemented among sexual and gender minorities. All interventions addressed stigma. We identified 37 eligible interventions. Most interventions targeted sexual minority men. Interventions were frequently developed or adapted for implementation among sexual and gender minorities and addressed multiple levels and types of stigma. Interventions most frequently targeted proximal stressors, including internalized and anticipated stigma. HIV and mental health were the most commonly targeted health outcomes. A limited number of studies investigated the moderating or mediating effects of stigma on intervention efficacy. The application of an intersectional framework was frequently absent and rarely amounted to addressing sources of stigma beyond sexual and gender minority identities. A growing number of interventions address sexual and gender minority stigma in an effort to prevent deleterious health effects. Future research is needed to assess whether stigma modifies the effectiveness of existing psychological and behavioral interventions among sexual and gender minorities. Further, the application of intersectional frameworks is needed to more comprehensively intervene on multiple, intersecting sources of stigma faced by the diverse sexual and gender minority community.
Topics: Behavioral Medicine; Gender Identity; Humans; Sexual and Gender Minorities; Social Stigma; Stereotyping
PubMed: 33044540
DOI: 10.1093/tbm/ibz200 -
BMJ Open Oct 2020To assess the sex difference in the prevalence of COVID-19 confirmed cases. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To assess the sex difference in the prevalence of COVID-19 confirmed cases.
DESIGN
Systematic review and meta-analysis.
SETTING
PubMed, Cochrane Library and Google Scholar were searched for related information. The authors developed a data extraction form on an Excel sheet and the following data from eligible studies were extracted: author, country, sample size, number of female patients and number of male patients. Using STATA V.14 for analysis, the authors pooled the overall prevalence of men and/or women using a random-effect meta-analysis model. The authors examined the heterogeneity in effect size using Q statistics and I statistics. Subgroup and sensitivity analyses were performed. Publication bias was also checked.
PARTICIPANTS
Studies on COVID-19 confirmed cases were included.
INTERVENTION
Sex (male/female) of COVID-19 confirmed cases was considered.
PRIMARY AND SECONDARY OUTCOME MEASURES
The primary outcome was prevalence of COVID-19 among men and women.
RESULTS
A total of 57 studies with 221 195 participants were used in the analysis. The pooled prevalence of COVID-19 among men was found to be 55.00 (51.43-56.58, I=99.5%, p<0.001). Sensitivity analysis showed the findings were not dependent on a single study. Moreover, a funnel plot showed symmetrical distribution. Egger's regression test p value was not significant, which indicates absence of publication bias in both outcomes.
CONCLUSIONS
The prevalence of symptomatic COVID-19 was found to be higher in men than in women. The high prevalence of smoking and alcohol consumption contributed to the high prevalence of COVID-19 among men. Additional studies on the discrepancies in severity and mortality rate due to COVID-19 among men and women and the associated factors are recommended.
Topics: Alcohol Drinking; Betacoronavirus; COVID-19; Coronavirus; Coronavirus Infections; Female; Gender Identity; Humans; Male; Pandemics; Pneumonia, Viral; SARS-CoV-2; Sex Factors; Smoking
PubMed: 33028563
DOI: 10.1136/bmjopen-2020-040129 -
PloS One 2020To explore the scope, range, and nature of the existing literature on Mexican women who remain behind in their communities of origin while their partners migrate abroad.
OBJECTIVE
To explore the scope, range, and nature of the existing literature on Mexican women who remain behind in their communities of origin while their partners migrate abroad.
DESIGN
A scoping review informed by an intersectionality framework was conducted over four months, January-April 2020.
DATA SOURCES
The electronic databases Medline, PsyINFO, Global Health, CINAHL, Gender Studies Database, Dissertations & Theses Global, LILACS, IBECS, and Sociological Abstracts were searched.
REVIEW METHODS
Articles were included if they focused on Mexican women who remain behind across transnational spaces. Two independent reviewers screened and selected articles. Data were analyzed and synthesized using descriptive statistics for quantitative data and content analysis for qualitative data.
RESULTS
A total of 19 articles were included for analysis; within those, the methods used included quantitative (n = 5), qualitative (n = 11), mixed methods (n = 2), and intervention (n = 1). Most studies lacked a theoretical framework (n = 10); the majority were empirical published studies (n = 11), and most used interviews (n = 12) and surveys (n = 6) to collect data. All of the articles studied cis-heterosexual Mexican women. Major areas identified were 1) research context, 2) gender roles, and 3) women's health.
CONCLUSION
Implications for practice and future research are discussed.
Topics: Culture; Family; Female; Gender Identity; Humans; Loneliness; Mental Health; Mexico; Socioeconomic Factors; Spouses; Transients and Migrants; Women; Women's Health
PubMed: 32925976
DOI: 10.1371/journal.pone.0238525 -
International Journal of Environmental... Sep 2020Extensive research documents the health inequalities LGBTI people experience, however far less is known for people with intersex variation. This paper presents a review...
Extensive research documents the health inequalities LGBTI people experience, however far less is known for people with intersex variation. This paper presents a review of intersex health and healthcare inequalities by evaluating research published from 2012 to 2019. In total 9181 citations were identified with 74 records screened of which 16 were included. A synthesis of results spans nine quantitative, five qualitative and two narrative reviews. Literature was searched in Medline, Web of Science, Cochrane, PsychINFO and CINAHL. People with intersex variance experience a higher incidence of anxiety, depression and psychological distress compared to the general population linked to stigma and discrimination. Progressive healthcare treatment, including support to question normative binaries of sex and gender, aids understand of somatic intersex variance and non-binary gender identity, especially when invasive treatment options are avoided or delayed until individuals are able to self-identify or provide consent to treatment. Findings support rethinking sex and gender to reflect greater diversity within a more nuanced sex-gender spectrum, although gaps in research remain around the general health profile and the healthcare experiences of people with intersex variance. More large-scale research is needed, co-produced with peers who have lived experience of intersex variation to ensure policy, education and healthcare advances with greater inclusivity and ethical accountability.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Australia; Child; Cross-Sectional Studies; Female; Gender Identity; Health; Healthcare Disparities; Humans; Male; Middle Aged; Quality of Life; Sexual and Gender Minorities; Young Adult
PubMed: 32911732
DOI: 10.3390/ijerph17186533 -
Journal of Hypertension Feb 2021Gender-affirming hormone therapy (GHT) is utilized by people who are transgender to align their secondary sex characteristics with their gender identity. Data relating...
OBJECTIVES
Gender-affirming hormone therapy (GHT) is utilized by people who are transgender to align their secondary sex characteristics with their gender identity. Data relating to cardiovascular outcomes in this population are limited. We aimed to review the impact of GHT on the blood pressure (BP) of transgender individuals.
METHODS
We searched PubMed/MEDLINE, SCOPUS and Cochrane Library databases for articles published relating to the BP of transgender adults commencing GHT. Methodological quality was assessed via the 'Quality Assessment Tool for Before-After (Pre-Post) Studies with No Control Group'.
RESULTS
Six hundred articles were screened, of which 14 studies were included in this systematic review encompassing 1309 individuals (∼50% transgender men and women) treated with GHT between 1989 and 2019. These articles were all pre-post observational studies without control groups. Mean ages ranged between 23.0-36.7 years (transgender men) and 25.2-34.8 years (transgender women). Interventions were diverse and included oral, transdermal and injectable hormonal preparations with 4 months to 5 years follow-up. Most studies in transgender men did not demonstrate a change in BP, whereas transgender women on GHT demonstrated both increases and decreases in SBP. These studies were heterogenous with significant methodological limitations and only two were determined to have a good quality rating.
CONCLUSION
There is currently insufficient data to advise the impact of GHT on BP in transgender individuals. Better quality research is essential to elucidate whether exogenous sex hormones modulate BP in transgender people and whether this putative alteration infers poorer cardiovascular outcomes.
Topics: Adult; Blood Pressure; Blood Pressure Monitoring, Ambulatory; Cohort Studies; Female; Gender Identity; Hormones; Humans; Male; Middle Aged; Prospective Studies; Transgender Persons; Young Adult
PubMed: 32809982
DOI: 10.1097/HJH.0000000000002632 -
Health and Quality of Life Outcomes Aug 2020Several reports have demonstrated varying results on the quality of life (QoL) of the transgender population. Therefore, the aim of this study was to conduct a... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Several reports have demonstrated varying results on the quality of life (QoL) of the transgender population. Therefore, the aim of this study was to conduct a systematic review and meta-analysis about the quality of life (QoL) of individuals during the post transsexual surgery period.
METHODS
We searched major biomedical electronic databases, including Scopus, Google Scholar, Psychological Information Database (PsycInfo), Web of Science, PubMed, Excerpta Medica dataBASE (EMBASE), and ProQuest, for all relevant literature published in English up to December 2019. The included papers required to be cross sectional studies that reported quality of life in people with transsexuality post surgery. After selecting eligible studies, 2 authors extracted data of each study independently and resolved any inconsistency by consensus with the third reviewer. The risk of bias was assessed by 2 independent research experts by the Newcastle-Ottawa Scale (NOS).
RESULTS
In this study, out of 497 articles extracted from the initial investigation, 8 articles with 1099 patients were ultimately selected for meta-analysis. The pooled mean of quality of life in transsexual individuals was obtained to be 70.45 (95%CI 55.87-85.03) and 59.17 (95%CI 48.59-69.74), based on World Health Organization Quality of Life (WHOQoL-BREF) and The 36-item short form of the Medical Outcomes Study questionnaire (SF36), respectively. Also, the results of the subgroup analysis for the weighted mean quality of life in male to female and female to male showed that the mean quality of life in female to male was 57.54 (95%CI 42.24-72.84) and it was 62.47 (95%CI 45.94-79.00) in male to female, based on SF36 questionnaire. Moreover, the weighted mean quality of life in female to male was 69.99 (95%CI 43.76, 96.23) and it was 70.65 (95%CI 53.11, 88.19) in male to female, based on WHOQoL-BREF questionnaire.
CONCLUSION
The results of this systematic review may support the approaches to transsexuality that facilitates sex reassignment. In this review, the means of quality of life after surgery were not compared to the means of quality of life before surgery or even before hormonal therapy which was due to inadequate number of primary studies.
Topics: Cross-Sectional Studies; Female; Humans; Male; Quality of Life; Sex Reassignment Procedures; Surveys and Questionnaires; Transsexualism
PubMed: 32746856
DOI: 10.1186/s12955-020-01510-0