A Rapid Scoping Review of Gender Inequities in the Medical Profession

Introduction: There continue to be large inequities in the representation of women at progressive levels of training and seniority in both academic and community practice settings. Gender inequity in medicine is not only problematic in its own right but has the potential to deliver inequitable outcomes, including the neglect of important research and care that continues to disadvantage women patients. As significant evidence is emerging on gender inequities in the medical profession, it is an opportune time to review the current evidence on the persisting gaps, potential causes, and possible solutions. Methods: A rapid scoping review was conducted for articles on the topic of gender inequity and the medical profession in PubMed and Google Scholar. The search was limited to articles published from 1990 to the search date (June 1, 2017), and included only papers published in English. Results: An initial 1055 articles were screened according to established inclusion and exclusion criteria. After initial and full-text review, supplemented by a hand search through the article references, 45 articles were included in the review. Articles were classified as a) evidence for gender inequities, b) causes of inequities, and c) solutions for inequities. Only 13% of articles found (6 studies) addressed possible interventions to reduce inequities. Significant gaps exist in the literature, particularly around part-time work options, parental and family leave options, and ad-dressing implicit biases to reduce sexism in professional settings. Discussion: The evidence highlights substantial inequities in the representation of women in the medical profession, in both the academic and community settings, in medical literature, and in leadership positions. This review also highlighted substantial gaps in the literature on understanding what can be done to reduce these gaps. More research is needed in the area of gender inequities in medicine to improve the representation of women in medicine

Prevalence of Cardiovascular Risk Factors among Cancer Patients in the United States

Background: Cancer and cardiovascular diseases (CVDs) are leading causes of morbidity and mortality. We analyzed national data to examine the prevalence of CVD risk factors among adult cancer survivors in the United States. Methods: Participants included adults ≥18 years of age from the National Health and Nutrition Examination Survey 2001-2002 to 2013-2014. CVD risk factors included hypertension, diabetes, dyslipidemia, obesity, smoking, and physical activity. Prevalence of 1, 2, or ≥3 CVD risk factors was compared between cancer and noncancer participants. All CVD risk factors were adjusted for age and smoking and additionally for sex. Differences in CVD risk factors among cancer and noncancer participants were identified using logistic regression analysis. Results: Among 35,379 eligible participants, 2906 (8.4%) had a history of cancer. The proportion of participants having a single CVD risk factor was lower among cancer survivors compared with noncancer participants (25.8% vs. 33.9%, P \u3c 0.001). The proportions of participants having two CVD risk factors (33.5% vs. 24.6%, P \u3c 0.001) and ≥3 CVD risk factors (27.4% vs. 16.4%, P \u3c 0.001) were higher among cancer survivors. However, these associations lost significance upon adjusting for age. The odds of total hypertension (odds ratio [OR] 1.25, 95% confidence interval [CI]: 1.11-1.40) and total diabetes (OR 1.33, 95% CI: 1.08-1.65) were significantly higher among cancer survivors. Conclusions: Our study showed that adult cancer survivors in the United States had higher levels of CVD risk factors primarily due to age-related factors, in addition to cancer complications. There is a significant need for improved CVD risk assessment and prevention services for cancer survivors

Mental Health Impacts of Climate Change Among Vulnerable Populations Globally: An Integrative Review

Background: Climate change has been shown to be directly linked to multiple physiological sequelae and to impact health consequences. However, the impact of climate change on mental health globally, particularly among vulnerable populations, is less well understood. Objective: To explore the mental health impacts of climate change in vulnerable populations globally. Methods: We performed an integrative literature review to identify published articles that addressed the research question: What are the mental health impacts of climate change among vulnerable populations globally? The Vulnerable Populations Conceptual Model served as a theoretical model during the review process and data synthesis. Findings/Results: One hundred and four articles were selected for inclusion in this review after a comprehensive review of 1828 manuscripts. Articles were diverse in scope and populations addressed. Land-vulnerable persons (either due to occupation or geographic location), Indigenous persons, children, older adults, and climate migrants were among the vulnerable populations whose mental health was most impacted by climate change. The most prevalent mental health responses to climate change included solastalgia, suicidality, depression, anxiety/eco-anxiety, PTSD, substance use, insomnia, and behavioral disturbance. Conclusions: Mental health professionals including physicians, nurses, physician assistants and other healthcare providers have the opportunity to mitigate the mental health impacts of climate change among vulnerable populations through assessment, preventative education and care. An inclusive and trauma-informed response to climate-related disasters, use of validated measures of mental health, and a long-term therapeutic relationship that extends beyond the immediate consequences of climate change-related events are approaches to successful mental health care in a climate-changing world

Prevalence and Inpatient Hospital Outcomes of Malignancy-Related Ascites in the United States

Objective: Malignancy-related ascites (MRA) is the terminal stage of many advanced cancers, and the treatment is mainly palliative. This study looked for epidemiology and inpatient hospital outcomes of patients with MRA in the United States using a national database. Methods: The current study was a cross-sectional analysis of 2015 National Inpatient Sample data and consisted of patients ≥18 years with MRA. Descriptive statistics were used for understanding demographics, clinical characteristics, and MRA hospitalization costs. Multivariate regression models were used to identify predictors of length of hospital stay and in-hospital mortality. Results: There were 123 410 MRA hospitalizations in 2015. The median length of stay was 4.7 days (interquartile range [IQR]: 2.5-8.6 days), median cost of hospitalization was US$43 543 (IQR: US$23 485-US$82 248), and in-hospital mortality rate was 8.8% (n = 10 855). Multivariate analyses showed that male sex, black race, and admission to medium and large hospitals were associated with increased hospital length of stay. Factors associated with higher in-hospital mortality rates included male sex; Asian or Pacific Islander race; beneficiaries of private insurance, Medicaid, and self-pay; patients residing in large central and small metro counties; nonelective admission type; and rural and urban nonteaching hospitals. Conclusions: Our study showed that many demographic, socioeconomic, health care, and geographic factors were associated with hospital length of stay and in-hospital mortality and may suggest disparities in quality of care. These factors could be targeted for preventing unplanned hospitalization, decreasing hospital length of stay, and lowering in-hospital mortality for this population