Search Results (152)

The U.S. pharmacist workforce has undergone significant growth and demographic changes, particularly increased female participation and part-time employment. However, limited evidence exists on how labor supply behavior varies by gender and employment status. This study used a nationally representative sample of 12,064 pharmacists from the 2019–2022 American Community Survey (ACS) to examine heterogeneity in labor supply decisions. Ordinary Least Squares (OLS) regression models were estimated separately by employment status (full-time versus part-time) and gender. The dependent variable was the number of hours worked. Independent variables included wage rate, age, marital status, number of children, and race/ethnicity. Findings showed that women were more than twice as likely to work part-time as men and minority pharmacists were largely underrepresented in the study sample relative to nonminority pharmacists. Gender gaps in wages, hours worked, and demographic and family characteristics also differed markedly between full-time and part-time pharmacists. Finally, findings lent support to the contention than women are more likely to work fewer hours than men as they are expected to spend more hours at home raising children. Understanding how individual characteristics shape pharmacists’ labor supply, and how these relationships differ by gender and employment status, is essential for workforce planning and healthcare human resources policy. Full article

Background/Objectives: Prediabetes significantly increases the risk of type 2 diabetes and related complications. Limited data exist for prediabetes among minority groups in Israel, particularly Bedouins. In the Negev region, Jewish and Bedouin populations differ markedly in culture and socioeconomic status. This study aimed to identify gender- and ethnicity-specific predictors of prediabetes. Methods: This retrospective, population-based observational exploratory study used data from 28,754 adults aged 20–65 years insured by Clalit Health Services in Southern Israel (2010–2020). Individuals with prediabetes were matched 1:1 with controls by age, gender, ethnicity, and year of diagnosis. Multivariate logistic regression models stratified by gender and ethnicity identified independent predictors. Results: Prediabetes was identified at significantly younger ages among Bedouins than Jews (6.8 years in men, 11.3 in women). The strongest predictor across all subgroups was metabolic syndrome (OR 2.0–4.0). Gestational diabetes was a major risk factor in women, particularly Jewish (OR 3.6). Cardiovascular disease and the use of statins or thiazide diuretics were independently associated with increased odds of prediabetes. Triglyceride-to-HDL cholesterol ratio was consistently elevated among prediabetes patients. Conclusions: Metabolic and medication-related factors contribute significantly to prediabetes-associated risk, with distinct gender and ethnic patterns. Culturally tailored early interventions and individualized risk profiling may enhance diabetes prevention in Southern Israel. Full article

Persisting ethnic disparities in pre-eclampsia (PE), cardiovascular disease (CVD), and maternal mortality call for a paradigm shift in how ethnicity is understood as a risk factor for PE. Starting from a migrant perspective, we argue that the transgenerational experience of maternal stress within shared, yet dynamic ecosocial contexts can be linked to core pathophysiological features of PE. A growing body of evidence suggests how a vicious cycle of chronic maternal stress, cardiovascular dysfunction, placental ER stress, and endothelial dysfunction may serve as a catalyst for the transmission of altered cardiovascular and neuro-endocrine stress reactivity patterns across generations, with a seemingly important role for foetal programming and epigenetics. As these alterations in stress reactivity patterns have in turn been associated with an increased risk of PE and CVD later in life, the resulting transgenerational chain reaction may ultimately allow for ethnic disparities in PE to be traced back to historic, stressful moments in the shared ecosocial contexts of ethnic minority women. Reconceptualising ethnicity as a proxy for the stratified and embodied experience of transgenerational maternal stress within its unique ecosocial contexts, rather than a stand-alone, non-modifiable risk factor, will therefore open new directions for future research, clinical care, and policy interventions aimed at advancing maternal health equity. Full article

Background: Data on assisted reproductive technology (ART) outcomes among Roma women are virtually absent from the literature, despite Roma being the largest and most socioeconomically marginalized ethnic minority in Europe. This study provides the first structured evaluation of IVF/ICSI outcomes among Roma women at a tertiary fertility center. Methods: A retrospective observational cohort study was conducted at the Clinic for Gynecology and Obstetrics, University Clinical Center Niš, Serbia (May 2010–September 2015). Roma (n = 88) and non-Roma women (n = 1197) undergoing IVF/ICSI were compared on baseline clinical, hormonal, and embryological parameters. Primary and secondary outcomes were clinical pregnancy and live birth, respectively. Multivariable logistic regression, propensity score matching (1:4, by age and AMH), first-cycle sensitivity analysis, and a machine learning pipeline (logistic regression, random forest, XGBoost) with SHAP interpretability analysis were applied. Results: Roma women were significantly younger (31.9 ± 4.0 vs. 34.5 ± 4.7 years; p < 0.001) and had a more favorable ovarian reserve profile (AMH 3.78 vs. 2.90 ng/mL; p = 0.004; FSH 6.87 vs. 8.23 IU/L; p < 0.001), yet had a markedly longer duration of infertility (9.3 vs. 6.3 years; p < 0.001). Clinical pregnancy rates (48.9% vs. 41.3%; p = 0.179) and live birth rates (28.4% vs. 30.9%; p = 0.720) were comparable between groups. In multivariable logistic regression and propensity score-matched analyses, Roma ethnicity was not an independent predictor of either outcome. XGBoost SHAP analysis ranked Roma ethnicity last (11th of 11) in feature importance for both clinical pregnancy (mean |SHAP| = 0.033) and live birth (mean |SHAP| = 0.009). The dominant predictors were the number of embryos transferred, AMH, and age. Only 88 Roma women accessed ART over the decade-long study period, indicating profound underutilization of fertility services. Conclusions: No independent association was detected between Roma ethnicity and IVF/ICSI outcomes within the statistical power afforded by the Roma subgroup (n = 88). An exploratory first-cycle live birth signal (adjusted OR = 0.478; 95% CI 0.249–0.920; p = 0.027), not replicated in primary or propensity-matched analyses, is interpreted as hypothesis-generating. The extreme underutilization of ART services among Roma women remains the most clinically salient observation and a priority for targeted public health intervention. Full article

Tuberculosis (TB) remains a major public health burden in Vietnam, yet few studies have examined pulmonary TB mortality trends at sub-national levels, where local epidemiological patterns may differ substantially from national averages and reveal high-risk populations requiring targeted interventions and inform resource allocation. Lang Son, Vietnam, is a mountainous border province with many ethnic minority residents, and extensive cross-border movement creates distinct challenges for TB surveillance and treatment adherence. Although mortality has declined in line with national trends, rates in this border province remain higher than those in Vietnam’s major urban centers. This disparity suggests a hidden burden where Lang Son’s unique geographic challenges and ethnic diversity create health inequities that are often obscured by favorable national-level averages. To better understand local epidemiological patterns, this study examined temporal trends and gender differences in pulmonary TB mortality in Lang Son Province over a 12-year period (2005–2008 and 2011–2018). Using data from a population-based mortality registration system, we calculated crude and age-standardized mortality rates (ASR) per 100,000 person-years. Temporal trends were assessed using Poisson regression. The overall ASR was 7.7 per 100,000 person-years among men (95% CI: 6.5–9.0) and 1.9 among women (95% CI: 1.3–2.7), yielding a male-to-female ASR ratio of 4.1. The age-standardized pulmonary TB mortality declined by approximately 49.2% (from 6.3 (95% CI: 4.1–9.2) to 3.2 (95% CI: 1.9–4.9) per 100,000 person-years; p = 0.025). Notably, 69.9% of deaths occurred in individuals under age 70. While declines were observed in both sexes, sex-specific temporal trends were not statistically significant (p > 0.05). Despite these improvements, persistently higher mortality among men and older adults highlights ongoing inequities in TB outcomes within the province. These pre-pandemic findings provide an essential epidemiological baseline for assessing COVID-19’s impact on TB control and underscore the need for age- and gender-targeted interventions at sub-national levels to accelerate Vietnam’s progress toward TB elimination. Full article

Background: Despite well-established racial/ethnic disparities in cancer outcomes, little is known about the extent to which race/ethnicity influences adverse pregnancy outcomes (APOs) among women with early onset cancer. We evaluated racial/ethnic disparity in the occurrence of cancer during pregnancy and APOs among women with cancer in the United States. Methods: Data consisted of 17.6 million singleton deliveries among females aged 18–49 years from the National Inpatient Sample. Logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs). Results: From 2000 to 2022, the prevalence of births among women with cancer increased more than 225%, from 120.4 to 391.8 per 100,000. After accounting for sociodemographic and behavioral/lifestyle factors and comorbidity index among women with cancer (n = 49,824, mean age = 33.4 years), non-Hispanic Black women had the highest odds for hypertensive disorders of pregnancy (OR = 1.67, CI: 1.54–1.82), preterm birth (OR = 1.44, CI: 1.26–1.64) and fetal death (OR = 3.04, CI: 1.99–4.63). Asian or Pacific Islander and Native American women had the highest odds for gestational diabetes (OR = 2.48, CI: 2.17–2.85) and fetal growth restriction (OR = 1.92, CI: 1.00–3.69), respectively. Among racial/ethnic minority women, the odds for maternal mortality and several APOs were significantly higher among those with cancer than those without cancer, with the odds for APOs being highest for breast cancer (OR = 1.39, CI: 1.23–1.56). Conclusions: This large population-based study showed significant racial and ethnic disparities in APOs among women with a concurrent cancer diagnosis at delivery. Targeted management of APO risk factors during pregnancy among racial/ethnic minority populations with cancer may help reduce adverse maternal and neonatal outcomes. Full article

Continuing advances in cancer diagnosis and treatment, particularly in reproductive-aged patients, has led to numerous national medical organizations, including the American Society for Reproductive Medicine (ASRM), the American College of Obstetrics and Gynecology (ACOG), and the American Society for Clinical Oncology (ASCO), recommending prompt discussion of the potential gonadotoxic effects of chemotherapy and referral to a fertility specialist for counseling regarding possible fertility preservation. Despite overall increased utilization of assisted reproductive technology (ART) in the United States (US), racial and ethnic disparities persist on a multisystem level, ranging from decreased access and utilization of ART to inconsistent and delayed counseling to worse outcomes. While innovations in ART and cancer treatment continue to evolve in parallel, the beneficial impacts have been disparate and more limited in minority populations. This review specifically highlights racial and ethnic disparities in fertility preservation for women with cancer in the United States, highlights the underdeveloped state of this literature, and identifies possible pathways for improvement using the Disparities in Assisted Reproductive Technology (DART) hypothesis as a template. We address three main bottlenecks resulting in delay from time of cancer diagnosis to utilization of fertility preservation services. Full article

This paper aims to investigate the impact of ethnic diversity among employees and managers on firm performance, focusing on return on assets and return on equity. The analysis is conducted on a sample of 391 U.S. companies over a five-year period, 2020–2024. The quantitative framework includes a wide range of indicators related to financial performance, ethnic diversity among employees, ethnic categories of managers, and other control variables. The research methodology employs the ordinary least squares (OLS) method to highlight these effects, using fixed-effects and random-effects regression models, both linear and nonlinear. By estimating the regression models, the empirical results support the hypotheses established in the current state of the literature, indicating that ethnic diversity affects firm performance in a mixed manner, with both positive and negative effects on ROA and ROE. These findings are particularly relevant for practitioners, given the need to integrate minority representation into performance assessment, risk evaluation, and decision-making processes. Furthermore, regarding the female component within firms, this dimension contributes to the promotion of sustainability and a sound ESG-oriented approach. Consequently, social factors such as ethnicity can influence companies’ financial performance and shape how firms are perceived by investors. Full article

Climate action has been deemed as fundamental to counteract the impacts of rising global temperatures on health which will disproportionately affect low-income populations, racial and ethnic minorities, women, and other historically marginalized groups. Along with poverty reduction, inequality mitigation, gender equality promotion, and public health protection, climate action has been recognized as a fundamental goal for achieving Sustainable Development Goals (SDGs). However, despite growing recognition of the need to align climate action with development goals, there is a knowledge gap regarding how the implementation of climate change mitigation and adaptation policies impacts social inequalities. To address this knowledge gap, this document proposes a scoping review protocol aimed at identifying and synthesizing research that examines the impacts of climate policies on inequalities at the subnational scales, within the transport, infrastructure and health. The objective of this review is to map existing evidence, identify conceptual and empirical gaps and inform policy strategies that promote climate action in line with values of social justice and equality. Full article

The impacts of microaggressions and the Model Minority Myth on self-rated mental health among Asian American (AA) women are unclear. A total of 152 AA women completed an online questionnaire including select items from the Racial and Ethnic Microaggressions Scale (REMS) and the Internalization of the Model Minority Myth Measure (IM-4). Logistic regression was used to estimate associations (odds ratios and 95% confidence intervals) between the REMS and IM-4 with fair/poor mental health. Experiencing frequent microaggressions was significantly and consistently associated with fair/poor mental health, particularly those experiences involving exclusion or dismissal during interpersonal or professional interactions. Women who reported more microaggressions (>10), compared to those who reported fewer (<5), had more than twice the odds of fair/poor mental health (OR: 2.70, CI: 1.12, 6.49). For the IM-4, compared to those who were undecided, women who agreed with statements such as “Asian Americans have stronger work ethics” had lower odds of poor or fair/poor mental health: (OR: 0.39, CI: 0.15, 0.99) than those who were undecided. Gaining a greater understanding and acknowledgement of the impacts of subtle microaggressions and stereotyping, including internalization of stereotypes, is necessary to support psychological wellbeing and design effective mental health interventions for Asian American women. Full article

In Kazakhstan’s Akmola Region, rural households face heightened vulnerability from climate change, driven by reliance on weather-dependent resources and amplified risks of extreme precipitation events, prolonged dry spells, and progressive soil degradation—further intensified by limited adaptive capacity and inequities affecting women-led or ethnic minority families. This study conducted stratified household surveys across four agricultural districts, developed a tailored Livelihood Vulnerability Index (LVI) incorporating shelterbelt presence, condition, and perceived effects, alongside readiness for hydrological surface recovery (contour–strip organisation, swales/valokany, and tree–shrub planting). Results revealed an average LVI of 0.45–0.55, which was higher (+10–15%) in marginalized groups; testing pathways showed correlations (r = 0.65, p < 0.05) with water security, soil condition, income stability, and hazard reduction, with potential LVI reductions of 15–25% through integrated measures. District-specific recommendations include implementing the Potapenko–Lukin method on slopes <5% with valokany (width 80 cm, depth 1.5 m, spacing 100–500 m), endemic plantings, and biomaterial, supported by subsidies (488,028 tenge/ha/year) and GIS monitoring, to enhance resilience and equity in steppe and forest–steppe farming. Full article

Background: Colorectal cancer (CRC) incidence and mortality have declined in the United States over the past two decades, yet disparities persist by age, sex, race/ethnicity, and geography. To characterize population-level survival signals, we examined trends in age-adjusted incidence rates (AAIR), mortality rates (AAMR), and the mortality-to-incidence ratio (AAMIR) from 1999 to 2021, stratified by key subgroups. Methods: This retrospective analysis utilized de-identified data from the CDC WONDER United States Cancer Statistics database, encompassing incident CRC cases (SEER codes 21041–21052) and deaths (ICD-10 codes C18–C20) in adults aged 20 years and older. Age-adjusted rates (per 100,000, 2000 U.S. standard population) and AAMIR were calculated using Stata 17.0. Joinpoint regression identified trends (annual or average annual percent change [APC/AAPC], p < 0.05). Results: Among 3,489,881 cases and 1,225,986 deaths, AAIR decreased from 78.24 (1999) to 50.79 (2021; AAPC: −2.20%, 95% CI: −2.52 to −1.89), AAMR decreased from 29.34 to 17.92 (AAPC: −2.33%, −2.46 to −2.20), and AAMIR from 0.375 to 0.353 (AAPC: −0.08%, −0.47 to 0.30; p = 0.669). Women showed a significant AAMIR decline (AAPC: −0.29%), unlike men (AAPC: 0.07%). Young adults (20–39 years) had rising AAIR (AAPC: 2.42%) and AAMR (0.87%) but improving AAMIR (AAPC: −1.71%). Non-Hispanic Black individuals had the highest AAMIR (0.400 in 2021; AAPC: −0.54%). The Northeast had the most favorable AAMIR trend (AAPC: −0.40%), while the Midwest, South, and West were stable. States like New Jersey and Massachusetts achieved low AAMIR (0.292 and 0.304 in 2021), contrasting with Nebraska and Arizona (0.402 in both). Conclusions: Although colorectal cancer incidence and mortality have declined substantially in the United States from 1999 to 2021, the mortality-to-incidence ratio improved only marginally and remained markedly uneven across subgroups. Targeted interventions—enhancing screening and treatment access for men, racial/ethnic minorities, younger adults, and high-burden regions and states—can promote equitable outcomes. Full article

Background/Objectives: Iran carries a significant burden of mental health disorders. This study aimed to describe the status of mental health and mental health care in Iran between 2012 and 2023, addressing inequalities and mapping existing challenges in the mental health care system. Methods: A systematic literature review was conducted. Databases including Medline, CINAHL, APA PsycINFO, Scopus, Web of Science, and the Cochrane Library, as well as local databases such as SID, Magiran, and Noormags, were searched to identify studies related to mental health care in Iran. A total of 59 studies met the inclusion criteria. An inductive approach and thematic analysis were used to synthesize themes from the data. Results: Lower socioeconomic status (SES) was associated with higher rates of mental disorders due to poverty-related stressors and limited access to quality care. Gender disparities revealed that women are more vulnerable to mental health problems, exacerbated by perceived gender inequality. Ethnic minorities and undocumented migrant populations faced inadequate healthcare services, resulting in poorer mental health outcomes. Children and older adults also experienced mental health challenges influenced by sociodemographic factors. The main challenge for mental health care is establishing mechanisms to ensure more equitable access for all citizens. Additional challenges include limited awareness among policymakers, insufficient budget allocation, weak prevention programs, and poor intra- and inter-sectoral coordination and collaboration. A shortage of mental health care providers, as well as deficiencies in structure, system processes, and resources, further hinder progress. Conclusions: Socioeconomic factors exacerbate the challenges of Iran’s under-resourced mental health system. To address these issues, equity considerations must be integrated into mental health policies. Key interventions include the routine monitoring of mental health indicators, expanding insurance coverage for mental health services, and establishing dedicated services for children. Full article

Melanoma poses a growing concern for women of reproductive age, especially during pregnancy, when physiological changes can influence disease presentation and management. While women generally engage more in protective behaviors than men, significant disparities in awareness and preventive practices persist, particularly among racial and ethnic minorities. Pregnancy-associated hormonal and mechanical changes may alter the morphology of nevi, necessitating vigilant dermatologic monitoring. Photoprotection strategies should prioritize safety for both mother and fetus, emphasizing mineral-based sunscreens and behavioral interventions. Although standard diagnostic and treatment approaches remain broadly applicable during pregnancy, advanced melanoma presents unique therapeutic challenges. Targeted therapies like BRAF inhibitors may offer maternal benefits in selected cases, although data are limited, whereas immunotherapies require cautious consideration due to potential fetal risks. Ultimately, optimal care of melanoma during pregnancy demands a multidisciplinary approach that integrates dermatologic, obstetric, oncologic, and pediatric expertise to balance maternal health needs with fetal safety. This review addresses awareness and preventive behaviors in women of reproductive age, pregnancy-related changes in melanocytic nevi, and management considerations during pregnancy. Full article

This study adopts a systems perspective to examine the persistent effects of China’s One-Child Policy (OCP) on the subjective well-being of older adults, emphasizing structural persistence, reinforcing feedback, and path-dependent lock-in in complex socio-technical systems. Using nationally representative data from the China Longitudinal Aging Social Survey (CLASS-2014), we exploit the OCP’s formal rollout at the end of 1979—operationalized with a 1980 cutoff—as a quasi-natural experiment. A Fuzzy Regression Discontinuity (FRD) design identifies the Local Average Treatment Effect of being an only-child parent on late-life well-being, mitigating endogeneity from selection and omitted variables. Theoretically, we integrate three lenses—policy durability and lock-in, intergenerational support, and life course dynamics—to construct a cross-level transmission framework: macro-institutional environments shape substitution capacity and constraint sets; meso-level family restructuring reconfigures support network topology and intergenerational resource flows; micro-level life-course processes accumulate policy-induced adaptations through education, savings, occupation, and residence choices, with effects materializing in old age. Empirically, we find that the OCP significantly reduces subjective well-being among the first generation of affected parents decades later (2SLS estimate ≈ −0.23 on a 1–5 scale). The effects are heterogeneous: rural residents experience large negative impacts, urban effects are muted; men are more adversely affected than women; and individuals without spouses exhibit greater declines than those with spouses. Design validity is supported by a discontinuous shift in fertility at the threshold, smooth density and covariate balance around the cutoff, bandwidth insensitivity, “donut” RD robustness, and a placebo test among ethnic minorities exempt from strict enforcement. These results demonstrate how demographic policies generate lasting impacts on elderly well-being through transforming intergenerational support systems. Policy implications include strengthening rural pension and healthcare systems, expanding community-based eldercare services for spouseless elderly, and developing complementary support programs. Full article