Reasons and remedies for under-representation of women in medical leadership roles: a qualitative study from Australia

OBJECTIVE: To elicit medical leaders' views on reasons and remedies for the under-representation of women in medical leadership roles.

DESIGN: Qualitative study using semistructured interviews with medical practitioners who work in medical leadership roles. Interviews were transcribed verbatim and transcripts were analysed using thematic analysis.

SETTING: Public hospitals, private healthcare providers, professional colleges and associations and government organisations in Australia.

PARTICIPANTS: 30 medical practitioners who hold formal medical leadership roles.

RESULTS: Despite dramatic increases in the entry of women into medicine in Australia, there remains a gross under-representation of women in formal, high-level medical leadership positions. The male-dominated nature of medical leadership in Australia was widely recognised by interviewees. A small number of interviewees viewed gender disparities in leadership roles as a 'natural' result of women's childrearing responsibilities. However, most interviewees believed that preventable gender-related barriers were impeding women's ability to achieve and thrive in medical leadership roles. Interviewees identified a range of potential barriers across three broad domains-perceptions of capability, capacity and credibility. As a counter to these, interviewees pointed to a range of benefits of women adopting these roles, and proposed a range of interventions that would support more women entering formal medical leadership roles.

CONCLUSIONS: While women make up more than half of medical graduates in Australia today, significant barriers restrict their entry into formal medical leadership roles. These constraints have internalised, interpersonal and structural elements that can be addressed through a range of strategies for advancing the role of women in medical leadership. These findings have implications for individual medical practitioners and health services, as well as professional colleges and associations.

Patterns and demographic predictors of 5-year weight change in a multi-ethnic cohort of men and women in Australia

Objective: This study investigated 5-year trends in body weight, overweight and obesity and their association with sociodemographic variables in a large, multi-ethnic community sample of Australian adults.  Design: This prospective population study used baseline and 5-year follow-up data from participants in the Melbourne Collaborative Cohort Study (MCCS). Setting: Population study in Melbourne, Australia. Subjects: In total, 12 125 men and 17 674 women aged 35–69 years at baseline. Results: Mean 5-year weight change in this sample was +1.58 (standard deviation (SD) 4.82) kg for men and +2.42 (SD 5.17) kg for women. Younger (35–44 years) men and, in particular, women gained more weight than older adults and were at highest risk of major weight gain ($5 kg) and becoming overweight. Risk of major weight gain and associations between demographic variables and weight change did not vary greatly by ethnicity. Education level showed complex associations with weight outcomes that differed by sex and ethnicity. Multivariate analyses showed that, among men, higher initial body weight was associated with decreased likelihood of major weight gain, whereas among women, those initially overweight or obese were about 20% more likely to experience major weight gain than underweight or healthy weight women. Conclusions: Findings of widespread weight gain across this entire population sample, and particularly among younger women and women who were already overweight, are a cause for alarm. The prevention of weight gain and obesity across the entire population should be an urgent public health priority. Young-to-mid adulthood appears to be a critical time to intervene to prevent future weight gain.

Women in research? Investigating research opportunities for female academics in Australia

Women continue to be surprisingly under-represented in academia, given the increasing numbers of female postgraduate students and the flexible working conditions offered by most Australian Universities. To date, research has emphasised multiple causes for the 'gender gap' in academia, including the structural characteristics of the university system, cultural and societal barriers to the advancement of women, the influence of marital status on the productivity of women academics and the interaction of cultural, social and personality factors on women's professional careers. However, the implications of a 'gender gap' in academic rank reach beyond arguments of equality between sexes, to questions regarding consequences of a male-dominated professoriate to the nature and subjects of academic research in Australia. The aim of this paper is to investigate the factors that determine the rank of Australian academics and in part, to investigate whether there is a gender gap of rank or authority, through an analysis of data collected on all Australian academics by the Federal Department of Education, Science and Training. The implications of these findings on opportunities for female academic researchers and for research outcomes will be discussed.

Serum vitamin D and falls in older women in residential care in Australia

Objectives: To determine the prevalence of vitamin D deficiency in older people in residential care and the influence that the level of vitamin D may have on their incidence of falls.

Design: Prospective cohort.

Setting: Residential care facilities for older people in several states of Australia.

Participants: Six hundred sixty-seven women in low-level care and 952 women in high-level care, mean age 83.7 years.

Measurements: Serum 25-hydroxyvitamin D (25D) levels and recognized risk factors for falls including current medication use, a history of previous fractures, weight, tibial length (as a surrogate for height), cognitive function, walking ability, and frequency of going outdoors were determined. The women in low-level care and high-level care were followed for an average of 145 and 168 days, respectively. Falls were recorded prospectively in diaries completed monthly by residential care staff.

Results: Vitamin D deficiency (defined as a serum 25D level below 25 nmol/L) was present in 144 (22%) women in low-level care and 428 (45%) in high-level care. After excluding 358 bed-bound residents and adjusting for weight, cognitive status, psychotropic drug use, previous Colles fracture, and the presence of wandering behavior, log serum 25D level remained independently associated with time to first fall. The adjusted hazards ratio was 0.74 (95% confidence interval=0.59–0.94; P=.01), implying a 20% reduction in the risk of falling with a doubling of the vitamin D level.

Conclusion: Vitamin D deficiency is common in residential care in Australia. A low level of serum vitamin D is an independent predictor of incident falls.

Prevalence of genital human papillomavirus DNA in a sample of senior school-aged women in the Australian Capital Territory

Background: A strong association between persistent infection with oncogenic types of human papillomavirus (HPV) and cervical cancer is well established. Small numbers of international studies examining adolescent HPV infection and the risk factors associated are published, but there is currently no evidence on the prevalence and risk factors for HPV in an Australian, sexually active female adolescent population. Methods: To provide prevalence and risk factors for HPV in a female sexually active, senior high school population in the Australian Capital Territory (ACT), a convenience sample of 161, 16–19-year-old females attending a senior high school was evaluated. The sample formed part of a larger sample recruited for a study of sexually transmitted infections and blood-borne viruses in senior high school students. A clinical record was used to collect information about sexual and other risk behaviours, while self-collected vaginal swabs were tested for HPV DNA detection and genotyping using polymerase chain reaction. Results: The prevalence of HPV DNA in this sample overall was 11.2%, with multiple genotypes in 38%. No statistically significant associations were found between HPV DNA and the number of male partners, age of coitarche, time since first sexually active, condom use, smoking or alcohol intake. Conclusions: This is the first Australian study that has examined the prevalence and risk factors for genital HPV in this demographic group. The prevalence of HPV infection is slightly lower than reported in similar age groups overseas and is lower than other Australian studies in older women and those attending sexual health centres. Of HPV-positive young women, high-risk genotypes were found in over half, with more than one-third of HPV existing as multiple genotypes. Large community-based prevalence studies are needed to guide the development of recommendations for the vaccination of young women against HPV and to support other health promotion initiatives.

Measuring the impact of intimate partner violence on the health of women in Victoria, Australia

Objective: Using burden of disease methodology, estimate the health risks of intimate partner violence (IPV) among women in Victoria, Australia.

Methods: We calculated population attribute fractions (from survey data on the prevalence of IPV and the relative risks of associated health problems in Australia) and determined health outcomes by applying them to disability-adjusted life year estimates for the relevant disease and injury categories for Victoria, Australia for 2001.

Findings: For women of all ages IPV accounted for 2.9% (95% uncertainty interval 2.4-3.4%)  of the total disease and injury burden.  Among women 18-44 years of age, IPV was associated with 7.9% (95% uncertainty interval 6.4-935%) of the overall disease burden and was a larger risk to health than risk factors traditionally included in burden of disease studies, such as raised blood pressure, tobacco use and increased body weight.  Poor mental health contributed 73% and substance abuse 22% to the disease burden attributed to IPV.

Conclusion: Our findings suggest that IPV constitutes a significant risk to women's health.  Mental health policy-makers and health workers treating common mental health problems need to be aware that IPV is an important factor.  Future research should concentrate on evaluating effective interventions to prevent women being exposed to violence, and identifying the most appropriate mental health care for victims to reduce short- and long-term disability

Feminism's marginal problem: Women in management

Contemporary feminism has, from its inception, been ambivalent in its responses to the issue of women in management. On the one hand, feminists have recognised as a problem the limited numbers of women in management and the barriers that they encounter. They have promoted the development of programs such as affirmative action with, arguably, greater, or lesser success. At the same time, there has been a reluctance by some feminists to attach too much importance to the issue, given the manifestly more severe forms of discrimination encountered by other groups of women. According to this view, the problems of a privileged elite are a lesser priority, that is, marginal to more pressing feminist concerns.

This paper is based on research into career success predictors. It draws on work on culture and models of change in higher education to show that while interventions such as legislation granting maternity leave are significant initiatives to be strongly supported, the impact of such policies is mediated by the social rules of the organisation. These rules are a corollary of enduring value structures which are embedded in organisational cultures.

Research findings showed that the value systems, and especially the social rules which operate within organisations impact on men and women's career success differently. This research provides valuable insights into the mechanisms operating at several levels (at the organisational level as well as at the level of individual women) which tend to construct women as marginal in management.

Seeking to understand the marginality experienced by women in management has benefits that extend well beyond improving the lot of individual women managers. This is because better conceptualisations of marginality and, concomitantly, power in organisations can provide leverage for more far reaching changes for women generally.

Uncommon ground : white women in aboriginal history (Book review)

Book review of "Uncommon ground : white women in aboriginal history" by Anna Cole, Victoria Haskins, & Fiona Paisley.