medical paper 2020

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Trending Articles

• Depleting myeloid-biased haematopoietic stem cells rejuvenates aged immunity. Ross JB, et al. Nature. 2024. PMID: 38538791
• Embracing cancer complexity: Hallmarks of systemic disease. Swanton C, et al. Cell. 2024. PMID: 38552609 Review.
• Formation of memory assemblies through the DNA-sensing TLR9 pathway. Jovasevic V, et al. Nature. 2024. PMID: 38538785
• Transketolase promotes MAFLD by limiting inosine-induced mitochondrial activity. Tong L, et al. Cell Metab. 2024. PMID: 38547864
• Oxygen imaging of hypoxic pockets in the mouse cerebral cortex. Beinlich FRM, et al. Science. 2024. PMID: 38547288

Latest Literature

• Ann Rheum Dis (1)
• Arch Phys Med Rehabil (2)
• J Am Coll Cardiol (1)
• J Ethnopharmacol (4)
• J Neurosci (7)
• Nat Commun (22)
• Oncogene (1)
• Sci Rep (70)

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

An official website of the United States government

Here’s how you know

Official websites use .gov A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS A lock ( Lock A locked padlock ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.

Accelerating Biomedical Discovery and Data-Powered Health

Citations for biomedical literature

MedlinePlus

Reliable, up-to-date health information for you

An experimental multimedia search engine

Medical Subject Headings

ClinicalTrials.gov

A database of clinical studies, worldwide

Basic Local Alignment Search Tool

News and Highlights

Musings from the Mezzanine

Circulating Now

NCBI Insights

NLM Announcements

Technical Bulletin

NIH Virtual Tour: National Library of Medicine

The National Library of Medicine (NLM) is the world's largest biomedical library and a national resource for health professionals, scientists, and the public.

News Spotlight

NLM Researchers Solve an Enzyme Mystery

Watch the video to learn more!

Research at NLM

Nlm intramural research program.

Intramural research at NLM consists of the development and application of computational approaches to a broad range of problems in biomedicine, molecular biology, and health. READ RESEARCH HIGHLIGHTS | MEET OUR PRINCIPAL INVESTIGATORS | EXPLORE TRAINING OPPORTUNITIES

Historical Collections at NLM

Biomedical and clinical informatics at nlm, health it and health data standards.

Efficient health care information exchange in the US and worldwide is made possible by NLM’s work with IT Data Standards.

Learn about NLM’s contributions to Health IT

Unified Medical Language System (UMLS) Terminology Services

This set of tooling services brings together many health and biomedical vocabularies and standards to enable interoperability between computer systems.

Explore UMLS

Biomedical Informatics Training Program

This training program provides biomedical and clinical informatics training and research opportunities for individuals at various stages in their career.

Investigate training opportunities

The Library started as a shelf of books in the Surgeon General’s office in 1836 but has grown to a collection of millions of print and electronic resources.

Explore our past

Organization

The diverse centers, divisions, advisory bodies and other organizational units that make up NLM contribute in myriad ways to the Library’s mission.

Explore the Library

Strategic Plan

This ten year plan outlines NLM's role in a future where data and information transform and accelerate biomedical discovery and improve health and health care.

VIEW OUR STRATEGIC PLAN

BMJ's Coronavirus (covid-19) Hub

BMJ's covid-19 hub supports health professionals and researchers with practical guidance and online CPD courses, as well as free access to the latest news, comment, and research from The BMJ. Covid-related research content from the rest of our portfolio of journals is also freely available for a year.

BMJ is committed to providing access to covid-related materials to those who need them. If you require access to an article that is no longer freely available, please contact [email protected] with the subject line "Covid Article Request".

What you need to know

Highlights from the bmj, uk workers during the pandemic: inadequate protection and, consequently, increased risk.

01 March 2024

US public health after covid-19: learning from the failures of the hollow state and racial capitalism

05 February 2024

Essential workers during covid-19: how quickly we forget

25 January 2024

Covid-19 has cut UK life expectancy by around half a year, data suggest

12 January 2024

Learning to live with covid-19: testing, vaccination, and mask wearing still play a key part in managing the pandemic

14 December 2023

Covid inquiry: What did Johnson say about underestimated risks, excess deaths, and his missing WhatsApps?

11 December 2023

Embedding implementation research to cross the quality of care chasm during the covid-19 pandemic and beyond

Communicating scientific advice: lessons from the uk covid-19 inquiry.

07 December 2023

Covid-19 vaccine effectiveness against post-covid-19 condition among 589 722 individuals in Sweden: population based cohort study

22 November 2023

Equity and technology in the pandemic treaty

03 November 2023

The FDA and Moderna’s cosy relationship: how lax rules enable a revolving door culture

01 November 2023

What do we know about covid in immunocompromised people?

25 October 2023

Labour’s proposed covid corruption commissioner: an important signal, but it won’t be easy to get the money back

Clinical guidance, a living who guideline on drugs to prevent covid-19.

24 March 2023

A living WHO guideline on drugs for covid-19

14 July 2022

Covid-19 diagnosis and management

BMJ Best Practice provides regularly updated information on prevention, diagnosis, management, follow up

Covid and MS, . . . and other stories

08 February 2024

Diagnosis of venous thromboembolic diseases in people with covid-19: summary of updated NICE guidance

12 October 2023

Pathophysiology, diagnosis, and management of neuroinflammation in covid-19

18 August 2023

Breathing difficulties after covid-19: a guide for primary care

14 June 2023

Orthostatic tachycardia after covid-19

24 February 2023

Update to living WHO guideline on drugs for covid-19

12 January 2023

Long covid—an update for primary care

22 September 2022

Covid-19 vaccination in pregnancy

10 August 2022

Diagnosis and management of covid-19 in pregnancy

26 April 2022

From The BMJ

Clinical effectiveness of an online supervised group physical and mental health rehabilitation programme for adults with post-covid-19 condition (regain study): multicentre randomised controlled trial.

07 February 2024

Efficacy and safety of an inactivated virus-particle vaccine for SARS-CoV-2, BIV1-CovIran: randomised, placebo controlled, double blind, multicentre, phase 3 clinical trial

21 September 2023

Long term risk of death and readmission after hospital admission with covid-19 among older adults: retrospective cohort study

09 August 2023

Safety of BA.4-5 or BA.1 bivalent mRNA booster vaccines: nationwide cohort study

25 July 2023

Comparative effectiveness of bivalent BA.4-5 and BA.1 mRNA booster vaccines among adults aged ≥50 years in Nordic countries: nationwide cohort study

Comparative effectiveness of heterologous third dose vaccine schedules against severe covid-19 during omicron predominance in nordic countries: population based cohort analyses.

24 July 2023

From BMJ Journals

Lessons from covid-19 syndromic surveillance through emergency department activity: a prospective time series study from western switzerland, covid-19, body weight and the neighbourhood: food system dimensions and consumption associated with changes in body weight of peruvian adults during first wave lockdowns, impact of physical activity on covid-19-related symptoms and perception of physical performance, fatigue and exhaustion during stay-at-home orders, effectiveness of ehteraz digital contact tracing app versus conventional contact tracing in managing the outbreak of covid-19 in the state of qatar, vaccine rollout.

Protecting infants through covid-19 vaccination during pregnancy

Maternal mrna covid-19 vaccination during pregnancy and delta or omicron infection or hospital admission in infants: test negative design study, investing in robust surveillance of the effects of covid-19 and future emerging infections in pregnancy should be prioritised, ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses, effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials, use of progestogens and the risk of intracranial meningioma: national case-control study, rosuvastatin versus atorvastatin treatment in adults with coronary artery disease: secondary analysis of the randomised lodestar trial, added benefit and revenues of oncology drugs approved by the european medicines agency between 1995 and 2020: retrospective cohort study, 25 year trends in cancer incidence and mortality among adults aged 35-69 years in the uk, 1993-2018: retrospective secondary analysis, covid inquiry: what we have learnt about wales’s response.

11 March 2024

Covid-19 taskforce called for a new national vaccine agency to prepare for future pandemics

29 February 2024

Covid inquiry: What did we learn this week?

26 January 2024

Covid-19: Doctors instruct law firm in bid for compensation after developing long covid

Covid-19: vaccines have saved at least 1.4 million lives in europe, who reports.

17 January 2024

Covid-19: Undervaccination was associated with higher risk of hospital admission or death, study finds BMJ 2024; 384 doi: htt

16 January 2024

Covid-19: NICE plans to expand Paxlovid eligibility to 1.4 million more people

11 January 2024

Covid-19: Some US states and hospitals recommend masks again

05 January 2024

Covid-19: WHO adds JN.1 as new variant of interest

21 December 2023

Covid-19: Bereaved families group collects BMJ award for holding ministers to account

15 December 2023

Covid inquiry: Sunak defends his pandemic policies made as chancellor

13 December 2023

Covid-19: Preliminary figures show 1.2% of people in England had infection at end of November

Pfizer sues poland over unclaimed covid vaccines.

28 November 2023

Covid inquiry: The week that science became both bamboozling and a millstone

27 November 2023

Clinicians with long covid must get financial support, say unions

17 November 2023

Covid-19: Whitehall chaos and misplaced confidence undermined UK’s response, inquiry hears

Gp who left retirement to work in pandemic has been struck off for antivaccine comments and berating many social groups.

27 October 2023

Covid inquiry: Government developed intervention package without scientists’ advice before second lockdown

23 October 2023

Prisons and pandemic preparedness

24 April 2023

How pandemic publishing struck a blow to the visibility of women’s expertise

06 April 2023

Closing the gap in childhood immunisation after the pandemic

21 March 2023

WHO keeps covid-19 a public health emergency of international concern

06 March 2023

Financing covid-19 mRNA vaccines

01 March 2023

08 February 2023

Hancock’s covid inquiry evidence offers few clues as to why long covid was sidelined

Helen salisbury: covid booster chaos.

05 September 2023

Outsourcing covid-19 vaccination to the private sector will increase health inequalities

04 September 2023

Why older adults can continue to benefit from covid-19 boosters

Weakened by a decade of austerity: why the uk’s covid-19 inquiry is right to look at policies since 2010.

06 June 2023

The covid public health emergency is ending: it now joins the ordinary emergency that is American health

26 April 2023

Employers must provide better support to workers with long covid

Helen salisbury: unexplained symptoms aren’t always long covid, latest covid-19 blogs from bmj journals.

A centralised hub of all the latest covid-19 blogs and podcasts posts from BMJ's 70 specialty journals. All posts are freely available and you can search by subject area or journal.

Treat your patients with confidence

BMJ Learning offers our most relevant CPD online courses to update and refresh clinical knowledge for those supporting our healthcare systems in the diagnosis and treatment of covid-19

(16 COURSES)

Infographics

Updated: 1 Dec 2021

Updated: 22 June 2021

Updated: 11 August 2020

Covid-19 jobs

Follow us on, content links.

• Collections
• Health in South Asia
• Women’s, children’s & adolescents’ health
• News and views
• BMJ Opinion
• Rapid responses
• Editorial staff
• BMJ in the USA
• BMJ in South Asia
• Submit your paper
• BMA members
• Subscribers
• Advertisers and sponsors

Explore BMJ

• Our company
• BMJ Careers
• BMJ Learning
• BMJ Masterclasses
• BMJ Journals
• BMJ Student
• Academic edition of The BMJ
• BMJ Best Practice
• The BMJ Awards
• Email alerts
• Activate subscription

Information

View the latest institution tables

View the latest country/territory tables

Google Scholar reveals its most influential papers for 2021

Early clinical observations of COVID-19 and its mortality risk factors among the most cited output, while a five-year-old AI paper continues to command attention.

Examples of using SSD, an object-detection algorithm described in a highly cited artificial intelligence paper. Credit: Wei Liu et al. European Conference on Computer Vision (2016)

24 August 2021

Wei Liu et al. European Conference on Computer Vision (2016)

Examples of using SSD, an object-detection algorithm described in a highly cited artificial intelligence paper.

COVID-19-related papers have eclipsed artificial intelligence research in the annual listing of the most highly-cited publications in the Google Scholar database. The most highly cited COVID-19 paper, published in The Lancet in early 2020, has garnered more than 30,000 citations to date (see below for paper summary).

But, in the database of almost 400 million academic papers and other scholarly literature, even it fell a long way short of the most highly cited paper of the last five years, ‘Deep Residual Learning for Image Recognition’, published in Proceedings of the IEEE/CVF Conference on Computer Vision and Pattern Recognition by a team from Microsoft in 2016.

The five-year-old paper’s astonishing ascendancy continues, from 25,256 citations in 2019 to 49,301 citations in 2020 to 82,588 citations in 2021. We wrote about it last year here .

The 2021 Google Scholar Metrics ranking tracks papers published between 2016 and 2020, and includes citations from all articles that were indexed in Google Scholar as of July 2020. Google Scholar is the largest database in the world of its kind.

Below we describe selections from Google Scholar’s most highly-cited articles for 2021. COVID-19 research dominated new arrivals in the list, but we’re also featuring a popular AI paper from 2016, and research that provides an economical shortcut to seeing patterns of human genetic variation, also from 2016.

See our coverage of the 2019 and 2020 lists.

‘Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China’

30,529 citations

Published in February 2020, this is one of the earliest papers to describe the clinical characteristics of COVID-19. It was authored by researchers in China and doctors working in hospitals in Wuhan, the city where COVID-19 was first detected in late 2019.

The team, from institutions such as the Jin Yin-tan Hospital in Wuhan and China-Japan Friendship Hospital in Beijing, reviewed the clinical and nursing reports, chest X-rays and lab results of the first 41 COVID-19 patients. They noted that the novel virus acts similarly to SARS and MERS, in that it causes pneumonia, but is different in that it seldom manifests as a runny nose or intestinal symptoms.

The final sentences of the paper call for robust and rapid testing, because of the likelihood of the disease spreading out of control:

“Reliable quick pathogen tests and feasible differential diagnosis based on clinical description are crucial for clinicians in their first contact with suspected patients. Because of the pandemic potential of 2019-nCoV, careful surveillance is essential to monitor its future host adaption, viral evolution, infectivity, transmissibility, and pathogenicity.”

The paper has been referenced or cited in almost 100 policy documents to date , including several released by the World Health Organization on topics such as mask-wearing and clinical care of patients with severe symptoms .

‘Clinical Characteristics of Coronavirus Disease 2019 in China’

New England Journal of Medicine

19,656 citations

Published online in February 2020, this study was a retrospective review of medical records for 1,099 COVID-19 cases reported to the National Health Commission of the People's Republic of China between 11 December 2019 and 29 January 2020.

The team, which included almost 40 researchers from China from institutions such as the Guangzhou Medical University in Guangzhou and Wuhan Jinyintan Hospital in Wuhan, accessed electronic medical records from 552 hospitals in mainland China to summarise exposure risk, signs and symptoms, laboratory and radiologic findings related to COVID-19 infection.

The study garnered a lot of media attention based on the evidence it put forward that men might be more severely impacted by disease – 58% of the patient cohort were male.

However, as Sharon Begley reported for STAT , “It’s possible the apparent sex imbalance reflects patterns of travel and contacts that make men more likely to be exposed to carriers of the virus, not any inherent biological differences. It’s also possible the apparent worse disease severity in men could skew the data.”

A paper published in JAMA around the same time by researchers in the United States reported that, among hospitalized patients, there is “a slight predominance of men”.

A Nature Communications meta-analysis , published in December 2020, looked at 92 studies covering more than three million patients and concluded that, while males and females appeared to be susceptible to infection, men were 2.84 times more likely to be end up in intensive care and 1.39 times more likely to die from the disease.

‘Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study’

17,047 citations

Published in March 2020, The Lancet described this study as the first time researchers have examined risk factors associated with severe symptoms and death in hospitalised or deceased patients. Of the 191 patients studied, 137 were discharged from hospital and 54 died.

The study, by researchers from hospitals in China, also presented new data on viral shedding – information that informed early understanding of how the virus spreads and can be detected over the cause of infection.

“The extended viral shedding noted in our study has important implications for guiding decisions around isolation precautions and antiviral treatment in patients with confirmed COVID-19 infection,” said co-lead author, Bin Cao, from the China-Japan Friendship Hospital and Capital Medical University in Beijing.

“However, we need to be clear that viral shedding time should not be confused with other self-isolation guidance for people who may have been exposed to COVID-19 but do not have symptoms, as this guidance is based on the incubation time of the virus.”

‘A Novel Coronavirus from Patients with Pneumonia in China, 2019’

The New England journal of medicine

16,194 citations

On 31 December 2019, the Chinese Center for Disease Control and Prevention (China CDC) dispatched a rapid response team to accompany health authorities in Hubei province and Wuhan city in conducting COVID-19 investigations.

This study, published in January 2020, reported the results of that investigation, including the clinical features of the pneumonia of two patients.

Described by Jose Manuel Jimenez-Guardeño, a researcher in the Department of Infectious Diseases at King's College London , UK and colleagues in an article for The Conversation as “the article that released this virus to the world”, the paper details how the virus was isolated from patients with pneumonia in Wuhan in cell cultures.

“In fact, actual photographs of SARS-CoV-2 were shown to the world for the first time here,” say Jimenez-Guardeño and his co-authors .

The study authors urged that more epidemiologic investigations were needed in order to characterize transmission modes, reproduction intervals and other characteristics of the virus to inform strategies to control and stop its spread.

‘SSD: Single Shot MultiBox Detector’

European Conference on Computer Vision

15,368 citations

A change of pace from recent COVID-19 studies, this paper, led by Wei Liu from the University of North Carolina at Chapel Hill and published in 2016, remains one of the most highly cited in the field of artificial intelligence (AI). It describes a new method for detecting objects in images or video footage using a single deep neural network – a set of AI algorithms inspired by the neurological processes that fire in the human cerebral cortex.

The approach, called the Single Shot MultiBox Detector, or SSD, has been described as faster than Faster R-CNN – another object detection technology that was described in a very highly cited paper published in 2015 ( see our coverage here ).

SSD works by dividing the image into a grid, with each grid cell responsible for detecting objects within that part of the image. As the name indicates, the network is able to identify all objects within an image in a single pass, allowing for real-time analysis.

SSD is now one of a handful of object detection technologies that are now available. YOLO (You Only Look Once) is a similar single-shot object detection algorithm, whereas R-CNN and Faster R-CNN use a two-step approach , which involves first identifying the regions where objects might be, and then detecting them.

‘Analysis of protein-coding genetic variation in 60,706 humans’

7,696 citations

Led by Monkol Lek from the University of Sydney in Australia and Daniel MacArthur from the Broad Institute of MIT and Harvard University , this 2016 paper presents an open-access catalogue of more than 60,000 human exome sequences (exomes are the coding portions of genes) from people of European, African, South Asian, East Asian, and Latinx ancestry.

The collection was compiled as part of the Exome Aggregation Consortium project, run by an international group of researchers with a focus on exome sequencing. As exomes only make up about 2% of the human genome , the approach has been praised for being able to highlight patterns of genetic variation, including known disease-related variants, in a more cost-effective way than whole-genome sequencing.

Presented at a 2015 genomics conference, the catalogue encompasses 7.4 million genetic variants, which can be used to identify those connected to rare diseases. “Large-scale reference datasets of human genetic variation are critical for the medical and functional interpretation of DNA sequence changes,” Lek said when the paper was published.

• Alzheimer's disease & dementia
• Arthritis & Rheumatism
• Attention deficit disorders
• Autism spectrum disorders
• Biomedical technology
• Diseases, Conditions, Syndromes
• Endocrinology & Metabolism
• Gastroenterology
• Gerontology & Geriatrics
• Health informatics
• Inflammatory disorders
• Medical economics
• Medical research
• Medications
• Neuroscience
• Obstetrics & gynaecology
• Oncology & Cancer
• Ophthalmology
• Overweight & Obesity
• Parkinson's & Movement disorders
• Psychology & Psychiatry
• Radiology & Imaging
• Sleep disorders
• Sports medicine & Kinesiology
• Vaccination
• Breast cancer
• Cardiovascular disease
• Chronic obstructive pulmonary disease
• Colon cancer
• Coronary artery disease
• Heart attack
• Heart disease
• High blood pressure
• Kidney disease
• Lung cancer
• Multiple sclerosis
• Myocardial infarction
• Ovarian cancer
• Post traumatic stress disorder
• Rheumatoid arthritis
• Schizophrenia
• Skin cancer
• Type 2 diabetes
• Full List »

share this!

April 1, 2024

This article has been reviewed according to Science X's editorial process and policies . Editors have highlighted the following attributes while ensuring the content's credibility:

fact-checked

peer-reviewed publication

trusted source

Rapid rise seen in mental health diagnosis and care during and after pregnancy

by University of Michigan

Mental health issues during pregnancy or the first year of parenthood have a much greater chance of getting detected and treated now than just over a decade ago, a trio of new studies suggests.

But the rise in diagnosis and care hasn't happened equally across different groups and states, leaving some pregnant or postpartum individuals more likely to suffer through treatable symptoms that can put themselves and their newborn at risk.

In general, the studies show rises in diagnoses of anxiety, depression and post-traumatic stress disorder during pregnancy and the first year after giving birth in Americans with private insurance from 2008 to 2020. Treatment—both with psychotherapy and medications—also rose in this population.

The findings, published in three papers in the April issue of the journal Health Affairs , come from a team at the University of Michigan who study mental health in the perinatal period .

Their analysis groups multiple conditions diagnosed during this period under the label PMAD, short for perinatal mood and anxiety disorders. In general, PMAD includes depressive and anxiety disorders that occur any time during pregnancy and the postpartum year.

Key findings from 2008 to 2020 in privately insured people age 15 to 44:

• The rate of perinatal PTSD diagnosis quadrupled , to nearly 2% of all those pregnant or postpartum in 2020. Most of the rise was among those also diagnosed with PMAD; PTSD is considered an anxiety disorder in reaction to trauma.
• The rate of PMAD diagnoses nearly doubled , with the greatest increases seen since 2015. By 2020, 28% of those pregnant or postpartum received a PMAD diagnosis.
• The rate of suicidal thoughts or acts among pregnant and recently delivered people more than doubled overall, based on information reported to insurance companies. But the rate dropped among all those who had received a PMAD diagnosis.
• The rate at which patients who were pregnant or postpartum received psychotherapy—any form of talk therapy paid for by their private insurance—more than doubled. The rate of psychotherapy among those diagnosed with a PMAD condition increased 16% across the entire study period, with a clear increase after 2014.
• The rate of antidepressant medication prescriptions during pregnancy and the postpartum period rose overall , but the rate rose fastest among those diagnosed with a PMAD during pregnancy. The rate of antidepressant prescribing rose especially sharply after multiple guidelines for clinicians treating PMAD came out in 2015 and 2016. By 2020, just under half of those diagnosed with a PMAD received a prescription for an antidepressant.

"Taken together, these studies show a lot of movement in maternal mental health," said Stephanie Hall, Ph.D., a postdoctoral research fellow at the U-M Medical School Department of Psychiatry. "The landscape is different, at least as far as our health care system's ability to pick up on conditions and help people get treatment for them."

Hall is first author of the new papers on PTSD diagnosis and antidepressant prescribing in the perinatal period, and a co-author on the paper on PMAD diagnosis.

"If anything, the rates we're documenting for diagnosis and treatment are a floor, not a ceiling, based on what other studies have suggested about who is experiencing these symptoms," said Kara Zivin, Ph.D., a professor in the Medical School and School of Public Health who also holds positions with the VA Ann Arbor Healthcare System and Mathematica. "It's important that those who are struggling get help, because not getting care has consequences."

Zivin has spoken and written publicly about her own experience with a mental health crisis during pregnancy, including in Health Affairs.

Impacts of policy and guideline changes

The researchers say their findings suggest that many of the changes in diagnosis and care happened after increased insurance coverage through mental health parity laws and the Affordable Care Act, and after updated guidelines for clinicians emphasized increased use of screening, psychotherapy and medication.

Relevant guidelines include those issued by the American College of Obstetrics and Gynecology and the U.S. Preventive Services Task Force.

But they also note that increased societal awareness and acceptance of mental health conditions and care likely contributed to the trends seen in the new findings.

Another factor that could explain changes in diagnosis and treatment: the rise of collaborative care models , under which psychiatrists can offer expert consultations and resources to primary care teams caring for people of all ages with mental health conditions.

Since 2013, for instance, clinicians caring for pregnant and recently delivered individuals anywhere in Michigan can get assistance from the MC3 program run by Michigan Medicine, U-M's academic medical center.

The studies used data from private insurance companies, so they do not include people with low incomes covered by Medicaid, which covers about 40% of all births in the United States each year.

The data source also does not include those with other forms of government-funded insurance, those without insurance, and those with coverage by private insurance for less than two years.

So, the study findings mainly apply to those who have insurance through an employer (their own or that of another person who can cover them), and to those who bought private insurance individually, including after the launch of federal and state marketplaces under the ACA. The first marketplace plans offered coverage starting in 2014.

The studies include data for the first nine months of the pandemic, and the researchers hope to include more recent data in future studies.

Disparities in diagnosis and care

All of the studies show differences between groups of individuals in rates of diagnosis and treatment.

For instance, white individuals with PMAD were much more likely to receive antidepressant prescriptions during pregnancy than those of Black, Hispanic or Asian heritage. They were also more likely to be diagnosed with PTSD during the entire perinatal period, even though other research has shown that actual incidence of PTSD during the perinatal period is higher in people of color.

On the other hand, Black individuals as a group had the largest increase in PMAD diagnosis in the study period.

Of all age groups, people in the youngest group (15 to 24) had the largest increases in both PMAD diagnoses and antidepressant prescriptions during the study period. Those aged 15 to 26 were more likely to be diagnosed with PTSD than members of older age groups.

The PMAD diagnosis study also shows wide variation between states in the rate of individuals diagnosed with PMAD after the Affordable Care Act, compared with before.

The team plans to continue their state-level analysis, with new funding that will fuel studies of data from mental health surveys of individuals during the perinatal period. Their new research will look at changes over time in states where policies regarding reproductive care have gone into effect in recent years, including changes in abortion-related policies since the Supreme Court case that overturned the Roe vs. Wade decision in the Dobbs v. Jackson Women's Health Organization case in June 2022.

The researchers also plan to study the potential impact of other policy and clinical guideline changes.

The impact of telehealth-based perinatal mental health care since 2020, especially for those living in areas with shortages of mental health providers, also represents another important area to study, they say.

"Perinatal mental health has broad implications for babies and families," said Zivin. "The changes we've documented in these studies will have ripple effects for years to come."

Antidepressant Prescriptions Increased For Privately Insured People With Perinatal Mood And Anxiety Disorder, 2008–20, Health Affairs (2024), DOI: 10.1377/hlthaff.2023.01448 . www.healthaffairs.org/doi/10.1 … 7/hlthaff.2023.01448

Perinatal Mood And Anxiety Disorders Rose Among Privately Insured People, 2008–20, Health Affairs (2024), DOI: 10.1377/hlthaff.2023.01437 . www.healthaffairs.org/doi/10.1 … 7/hlthaff.2023.01437

Explore further

Feedback to editors

World's most powerful MRI scans first images of human brain

9 minutes ago

'Zombie neurons' shed light on how the brain learns

3 hours ago

Person is diagnosed with bird flu after being in contact with cows in Texas

16 hours ago

'Pathogen prospecting': Mosquito researchers track malaria's history by examining its epidemiology

Pilot study shows ketogenic diet improves severe mental illness

17 hours ago

Chatbot outperforms physicians in clinical reasoning, but also underperforms against residents on many occasions

Reducing late-night alcohol sales curbed all violent crimes by 23% annually in a Baltimore neighborhood: Study

Scientists pioneer immunotherapy technique for autoimmune diseases

Researchers develop more broadly protective coronavirus vaccine

Scientists discover speed of visual perception ranges widely in humans

18 hours ago

Related Stories

2008 to 2020 saw increase in perinatal mood and anxiety disorders

Mar 22, 2024

New study highlights disparities in mental health outcomes among immigrants before and after birth

Feb 21, 2024

More than one-third of insured Massachusetts individuals changed insurance type during the perinatal period

Nov 10, 2022

Medicaid eligibility during pandemic led to increased postpartum coverage, study suggests

Mar 8, 2024

Antidepressant dispensing to adolescents and young adults surges during pandemic

Feb 26, 2024

Perinatal depression linked to increased risk of death

Jan 10, 2024

Recommended for you

International study uses AI to show how personality influences the expression of our genes

22 hours ago

How music choices can affect productivity

Mar 29, 2024

Psychological care delivered by phone can help combat loneliness and depression, study finds

Steady rise in US suicides among adolescents, teens

Women with obesity do not need to gain weight during pregnancy, new study suggests

Mar 28, 2024

Let us know if there is a problem with our content

Use this form if you have come across a typo, inaccuracy or would like to send an edit request for the content on this page. For general inquiries, please use our contact form . For general feedback, use the public comments section below (please adhere to guidelines ).

Please select the most appropriate category to facilitate processing of your request

Thank you for taking time to provide your feedback to the editors.

Your feedback is important to us. However, we do not guarantee individual replies due to the high volume of messages.

E-mail the story

Your email address is used only to let the recipient know who sent the email. Neither your address nor the recipient's address will be used for any other purpose. The information you enter will appear in your e-mail message and is not retained by Medical Xpress in any form.

Newsletter sign up

Get weekly and/or daily updates delivered to your inbox. You can unsubscribe at any time and we'll never share your details to third parties.

More information Privacy policy

Donate and enjoy an ad-free experience

We keep our content available to everyone. Consider supporting Science X's mission by getting a premium account.

E-mail newsletter

Help | Advanced Search

Computer Science > Computer Vision and Pattern Recognition

Title: unleashing the potential of sam for medical adaptation via hierarchical decoding.

Abstract: The Segment Anything Model (SAM) has garnered significant attention for its versatile segmentation abilities and intuitive prompt-based interface. However, its application in medical imaging presents challenges, requiring either substantial training costs and extensive medical datasets for full model fine-tuning or high-quality prompts for optimal performance. This paper introduces H-SAM: a prompt-free adaptation of SAM tailored for efficient fine-tuning of medical images via a two-stage hierarchical decoding procedure. In the initial stage, H-SAM employs SAM's original decoder to generate a prior probabilistic mask, guiding a more intricate decoding process in the second stage. Specifically, we propose two key designs: 1) A class-balanced, mask-guided self-attention mechanism addressing the unbalanced label distribution, enhancing image embedding; 2) A learnable mask cross-attention mechanism spatially modulating the interplay among different image regions based on the prior mask. Moreover, the inclusion of a hierarchical pixel decoder in H-SAM enhances its proficiency in capturing fine-grained and localized details. This approach enables SAM to effectively integrate learned medical priors, facilitating enhanced adaptation for medical image segmentation with limited samples. Our H-SAM demonstrates a 4.78% improvement in average Dice compared to existing prompt-free SAM variants for multi-organ segmentation using only 10% of 2D slices. Notably, without using any unlabeled data, H-SAM even outperforms state-of-the-art semi-supervised models relying on extensive unlabeled training data across various medical datasets. Our code is available at this https URL .

Submission history

Access paper:.

• HTML (experimental)
• Other Formats

References & Citations

• Google Scholar
• Semantic Scholar

BibTeX formatted citation

Bibliographic and Citation Tools

Code, data and media associated with this article, recommenders and search tools.

• Institution

arXivLabs: experimental projects with community collaborators

arXivLabs is a framework that allows collaborators to develop and share new arXiv features directly on our website.

Both individuals and organizations that work with arXivLabs have embraced and accepted our values of openness, community, excellence, and user data privacy. arXiv is committed to these values and only works with partners that adhere to them.

Have an idea for a project that will add value for arXiv's community? Learn more about arXivLabs .

• Program Finder
• Admissions Services
• Course Directory
• Academic Calendar
• Hybrid Campus
• Lecture Series
• Convocation
• Strategy and Development
• Implementation and Impact
• Integrity and Oversight
• In the School
• In the Field
• In Baltimore
• Resources for Practitioners
• Articles & News Releases
• In The News
• Statements & Announcements
• At a Glance
• Student Life
• Strategic Priorities
• Inclusion, Diversity, Anti-Racism, and Equity (IDARE)
• What is Public Health?

Research Identifies Characteristics of Cities That Would Support Young People’s Mental Health

Survey responses from global panel that included young people provide insights into what would make cities mental health-friendly for youth

As cities around the world continue to draw young people for work, education, and social opportunities, a new study identifies characteristics that would support young urban dwellers’ mental health. The findings, based on survey responses from a global panel that included adolescents and young adults, provide a set of priorities that city planners can adopt to build urban environments that are safe, equitable, and inclusive. 

To determine city characteristics that could bolster youth mental health, researchers administered an initial survey to a panel of more than 400, including young people and a multidisciplinary group of researchers, practitioners, and advocates. Through two subsequent surveys, participants prioritized six characteristics that would support young city dwellers’ mental health: opportunities to build life skills; age-friendly environments that accept young people’s feelings and values; free and safe public spaces where young people can connect; employment and job security; interventions that address the social determinants of health; and urban design with youth input and priorities in mind. 

The paper was published online February 21 in  Nature .

The study’s lead author is Pamela Collins, MD, MPH, chair of the Johns Hopkins Bloomberg School of Public Health’s Department of Mental Health. The study was conducted while Collins was on the faculty at the University of Washington. The paper was written by an international, interdisciplinary team, including citiesRISE, a global nonprofit that works to transform mental health policy and practice in cities, especially for young people.

Cities have long been a draw for young people. Research by UNICEF projects that cities will be home to 70 percent of the world’s children by 2050. Although urban environments influence a broad range of health outcomes, both positive and negative, their impacts manifest unequally. Mental disorders are the leading causes of disability among 10- to 24-year-olds globally. Exposure to urban inequality, violence, lack of green space, and fear of displacement disproportionately affects marginalized groups, increasing risk for poor mental health among urban youth.

“Right now, we are living with the largest population of adolescents in the world’s history, so this is an incredibly important group of people for global attention,” says Collins. “Investing in young people is an investment in their present well-being and future potential, and it’s an investment in the next generation—the children they will bear.” 

Data collection for the study began in April 2020 at the start of the COVID-19 pandemic. To capture its possible impacts, researchers added an open-ended survey question asking panelists how the pandemic influenced their perceptions of youth mental health in cities. The panelists reported that the pandemic either shed new light on the inequality and uneven distribution of resources experienced by marginalized communities in urban areas, or confirmed their preconceptions of how social vulnerability exacerbates health outcomes. 

For their study, the researchers recruited a panel of more than 400 individuals from 53 countries, including 327 young people ages 14 to 25, from a cross-section of fields, including education, advocacy, adolescent health, mental health and substance use, urban planning and development, data and technology, housing, and criminal justice. The researchers administered three sequential surveys to panelists beginning in April 2020 that asked panelists to identify elements of urban life that would support mental health for young people.

The top 37 characteristics were then grouped into six domains: intrapersonal, interpersonal, community, organizational, policy, and environment. Within these domains, panelists ranked characteristics based on immediacy of impact on youth mental health, ability to help youth thrive, and ease or feasibility of implementation. 

Taken together, the characteristics identified in the study provide a comprehensive set of priorities that policymakers and urban planners can use as a guide to improve young city dwellers' mental health. Among them: Youth-focused mental health and educational services could support young people’s emotional development and self-efficacy. Investment in spaces that facilitate social connection may help alleviate young people’s experiences of isolation and support their need for healthy, trusting relationships. Creating employment opportunities and job security could undo the economic losses that young people and their families experienced during the pandemic and help cities retain residents after a COVID-era exodus from urban centers.  

The findings suggest that creating a mental health-friendly city for young people requires investments across multiple interconnected sectors like transportation, housing, employment, health, and urban planning, with a central focus on social and economic equity. They also require urban planning policy approaches that commit to systemic and sustained collaboration, without magnifying existing privileges through initiatives like gentrification and developing green spaces at the expense of marginalized communities in need of affordable housing.

The authors say this framework underscores that responses by cities should include young people in the planning and design of interventions that directly impact their mental health and well-being. 

“ Making cities mental health friendly for adolescents and young adults ” was co-authored by an international, interdisciplinary team of 31 researchers led by the University of Washington Consortium for Global Mental Health, Urban@UW, the University of Melbourne, and citiesRISE. Author funding is listed in the Acknowledgements section of the paper.

Related Content

Student Spotlight: Glendedora Dolce

Study Estimates Nearly 70 Percent of Children Under Six in Chicago May Be Exposed to Lead-Contaminated Tap Water

Hidden Food Insecurity: The Adolescents Who Aren’t Getting Enough to Eat

A Zero-Emissions Transition Would Save Kids’ Lives

Child Diarrhea Has a Cheap and Easy Fix—Why Isn’t It Reaching Patients?

Featured Clinical Reviews

• Screening for Atrial Fibrillation: US Preventive Services Task Force Recommendation Statement JAMA Recommendation Statement January 25, 2022
• Evaluating the Patient With a Pulmonary Nodule: A Review JAMA Review January 18, 2022
• Download PDF
• Share X Facebook Email LinkedIn
• Permissions

Best of Graphic Medicine—The 2023 Graphic Medicine International Collective Awards

• 1 Departments of Humanities and Medicine, Penn State College of Medicine, Hershey, Pennsylvania
• 2 Graphic Medicine International Collective
• The Arts and Medicine Graphic Medicine Michael J. Green, MD, MS; MK Czerwiec, RN, MA JAMA
• The Arts and Medicine Graphic Medicine: The Best of 2017 Michael J. Green, MD, MS; Susan M. Squier, PhD JAMA
• The Arts and Medicine Graphic Medicine, the Best of 2018 Michael J. Green, MD, MS; Mita Mahato, MA, PhD JAMA
• The Arts and Medicine Graphic Medicine—The Best of 2019 Michael J. Green, MD, MS; Lisa H. Plotkin, LCSW; Matthew N. Noe, MSLS JAMA
• The Arts and Medicine Graphic Medicine—The Best of 2020 Michael J. Green, MD, MS; Shelley Wall, AOCAD, MScBMC, PhD, CMI JAMA
• The Arts and Medicine Graphic Medicine—The Best of 2021 Michael J. Green, MD, MS; Brian Callender, MD JAMA
• The Arts and Medicine Graphic Medicine—The Best of 2022 Michael J. Green, MD, MS JAMA

The Graphic Medicine International Collective (GMIC) is a nonprofit organization founded in 2019 to guide and support the use of graphic narratives (ie, comics) in health. In 2022, GMIC launched an annual award to recognize and honor outstanding health-related comic projects published in the previous year. This article summarizes GMIC’s 2023 awards process ( Supplement ) and the awardees for outstanding long-form (>25 pages) and short-form (≤25 pages) works published in 2022.

Read More About

Green MJ , Wolf K. Best of Graphic Medicine—The 2023 Graphic Medicine International Collective Awards. JAMA. 2023;330(24):2323–2325. doi:10.1001/jama.2023.24478

Manage citations:

© 2024

Artificial Intelligence Resource Center

Cardiology in JAMA : Read the Latest

Browse and subscribe to JAMA Network podcasts!

Others Also Liked

Select your interests.

Customize your JAMA Network experience by selecting one or more topics from the list below.

• Academic Medicine
• Acid Base, Electrolytes, Fluids
• Allergy and Clinical Immunology
• American Indian or Alaska Natives
• Anesthesiology
• Anticoagulation
• Art and Images in Psychiatry
• Artificial Intelligence
• Assisted Reproduction
• Bleeding and Transfusion
• Caring for the Critically Ill Patient
• Challenges in Clinical Electrocardiography
• Climate and Health
• Climate Change
• Clinical Challenge
• Clinical Decision Support
• Clinical Implications of Basic Neuroscience
• Clinical Pharmacy and Pharmacology
• Complementary and Alternative Medicine
• Consensus Statements
• Coronavirus (COVID-19)
• Critical Care Medicine
• Cultural Competency
• Dental Medicine
• Dermatology
• Diabetes and Endocrinology
• Diagnostic Test Interpretation
• Drug Development
• Electronic Health Records
• Emergency Medicine
• End of Life, Hospice, Palliative Care
• Environmental Health
• Equity, Diversity, and Inclusion
• Facial Plastic Surgery
• Gastroenterology and Hepatology
• Genetics and Genomics
• Genomics and Precision Health
• Global Health
• Guide to Statistics and Methods
• Hair Disorders
• Health Care Delivery Models
• Health Care Economics, Insurance, Payment
• Health Care Quality
• Health Care Reform
• Health Care Safety
• Health Care Workforce
• Health Disparities
• Health Inequities
• Health Policy
• Health Systems Science
• History of Medicine
• Hypertension
• Images in Neurology
• Implementation Science
• Infectious Diseases
• Innovations in Health Care Delivery
• JAMA Infographic
• Law and Medicine
• Leading Change
• Less is More
• LGBTQIA Medicine
• Lifestyle Behaviors
• Medical Coding
• Medical Devices and Equipment
• Medical Education
• Medical Education and Training
• Medical Journals and Publishing
• Mobile Health and Telemedicine
• Narrative Medicine
• Neuroscience and Psychiatry
• Notable Notes
• Nutrition, Obesity, Exercise
• Obstetrics and Gynecology
• Occupational Health
• Ophthalmology
• Orthopedics
• Otolaryngology
• Pain Medicine
• Palliative Care
• Pathology and Laboratory Medicine
• Patient Care
• Patient Information
• Performance Improvement
• Performance Measures
• Perioperative Care and Consultation
• Pharmacoeconomics
• Pharmacoepidemiology
• Pharmacogenetics
• Pharmacy and Clinical Pharmacology
• Physical Medicine and Rehabilitation
• Physical Therapy
• Physician Leadership
• Population Health
• Primary Care
• Professional Well-being
• Professionalism
• Psychiatry and Behavioral Health
• Public Health
• Pulmonary Medicine
• Regulatory Agencies
• Reproductive Health
• Research, Methods, Statistics
• Resuscitation
• Rheumatology
• Risk Management
• Scientific Discovery and the Future of Medicine
• Shared Decision Making and Communication
• Sleep Medicine
• Sports Medicine
• Stem Cell Transplantation
• Substance Use and Addiction Medicine
• Surgical Innovation
• Surgical Pearls
• Teachable Moment
• Technology and Finance
• The Art of JAMA
• The Arts and Medicine
• The Rational Clinical Examination
• Tobacco and e-Cigarettes
• Translational Medicine
• Trauma and Injury
• Treatment Adherence
• Ultrasonography
• Users' Guide to the Medical Literature
• Vaccination
• Venous Thromboembolism
• Veterans Health
• Women's Health
• Workflow and Process
• Wound Care, Infection, Healing
• Register for email alerts with links to free full-text articles
• Access PDFs of free articles
• Manage your interests
• Save searches and receive search alerts

• Grade 5 Scholarship |
• O/L Past papers |
• 2024 O/L Model Papers |
• Royal College |
• Western Province |
• Online Book Shop
• Combined Maths
• Agricultural Science
• Business Studies
• Business Statistics
• Christianity
• Buddhist Civilization
• Drama and Theatre
• Political Science
• General English
• Agriculture
• Home Economics
• Indian History
• Sri Lankan History
• Grade 11 Papers
• Grade 10 Papers
• Grade 09 Papers
• Grade 08 Papers
• Grade 07 Papers
• Civic Education
• English Language
• Mathematics
• Second Language
• Sinhala Language
• Tamil Language
• Western Music
• Scholarship Exam Past Papers
• Scholarship Model Papers
• Environment
• Catholicism
• Grade 11 English Medium
• Grade 10 English Medium
• Grade 09 English Medium
• Grade 08 English Medium
• Grade 07 English Medium
• Grade 06 English Medium
• Sinhala Medium
• Sinhala Medium Answers
• English Medium
• English Medium Answers
• Tamil Medium
• Sinhala Medim Papers
• English Medium Papers
• Tamil Medium Papers
• Sinhala Medium Marking
• English Medium Marking
• Tamil Medium Marking
• Western Province
• North Western Province
• Southern Province
• North Central Province
• Central Province
• Sabaragamuwa Province
• Royal College
• Ananda College
• D.S.Senanayake
• Devi Balika
• Nalanda College
• Rathnavali Balika
• Visakha College
• Grade 11 Textbooks
• Grade 10 Textbooks
• Grade 9 Textbooks
• Grade 8 Textbooks
• Grade 7 Textbooks
• Grade 6 Textbooks
• WIKI Forum! Join

2020 O/L Health Past Paper and Answers | Sinhala Medium

G.C.E. Ordinary Level Health Past Paper and Answers 2020 in Sinhala Medium

Download 2020 O/L Health Past Paper and Answers in Sinhala Medium. You can download the following link Below. It’s free to download.  We have a large collection of previous Past papers on the O/L Health subject. You Can Check It Out.

Download From Here Download Preview Download Preview

You can click on this button to view this PDF file in your web browser without downloading it. And can be downloaded if necessary.

Please Join Telegram Group for predicted answers

previous Health Past Papers From here –

• 2019 O/L Health & Physical Education Marking Scheme | Sinhala Medium
• 2018 O/L Health & Physical Education Marking Scheme | Sinhala Medium
• 2018 O/L Health & Physical Education Past Paper | Sinhala Medium
• 2017 O/L Health & Physical Education Past Paper | Sinhala Medium
• 2016 O/L Health & Physical Education Past Paper | Sinhala Medium
• 2015 O/L Health & physical Education Past Paper | Sinhala Medium

If you have any problem with this post or PDF File you can add a comment below, or you can contact us on  Facebook . Share this resource with your friends!

2020 O/L Health Past Paper and Answers | English Medium

2020 o/l ict past paper and answers | sinhala medium.

Pastpapers WIKI

Pastpapers wiki is a free resource site for O/L and A/L Students In Sri Lanka. Pastpapers wiki was founded in October 2019 by Education Resources.lk. The main goal of this site is to provide Past Papers, Marking Schemes, Notes, and other resources that allow students to improve their knowledge.

plz come to making shit with helth

Examination department

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

Save my name, email, and website in this browser for the next time I comment.

Buy Books Online

Pastpapers wiki is a free resource site for O/L and A/L Students In Sri Lanka. Past Papers WiKi was founded in October 2019 by Education Resources.lk. The main goal of this site is to provide Past Papers, Marking Schemes, Notes, and other resources that allow students to improve their knowledge.

https://forum.pastpapers.wiki/ Email:  [email protected]

Become a Volunteer – Help Others 🙋‍♂️

We are currently looking for volunteers who are willing to share their expertise and contribute to our community by sharing educational materials in our forum. We’re looking for individuals who can help us create and share educational materials such as articles, videos, and social media posts that will inspire and educate others.

Share Past Papers 📝 | Help Others 🤝 Join With: https://forum.pastpapers.wiki/

Disclaimer of Past Papers WiKi

This website is continued for your personal appreciation or educational purposes only . All Content of this website is published by extracting the information from online sources such as official government websites, social media, other websites, etc. The copyrights of these contents belong to the responsible owners . If a modification will happen in this information, our website does not assume any responsibility. If you have any questions or suggestions, please contact us.

 – Mobile No:  071-8540371 –  Email:  [email protected]  

• Science stream
• Commerce stream
• Technology stream
• Arts Stream
• Common Subjects
• WIKI Forum!

Copyright 2019 -2021 © All rights reserved.

• International edition
• Australia edition
• Europe edition

Mystery in Japan as dangerous streptococcal infections soar to record levels

Health officials racing to identify cause of rise in streptococcal toxic shock syndrome, which has a 30% fatality rate

Experts warn that a rare but dangerous bacterial infection is spreading at a record rate in Japan , with officials struggling to identify the cause.

The number of cases in 2024 is expected to exceed last year’s record numbers, while concern is growing that the harshest and potentially deadly form of group A streptococcal disease – streptococcal toxic shock syndrome (STSS) – will continue to spread, after the presence of highly virulent and infectious strains were confirmed in Japan.

The National Institute of Infectious Diseases (NIID) said: “There are still many unknown factors regarding the mechanisms behind fulminant (severe and sudden) forms of streptococcus, and we are not at the stage where we can explain them.”

Provisional figures released by the NIID recorded 941 cases of STSS were reported last year. In the first two months of 2024, 378 cases have already been recorded, with infections identified in all but two of Japan’s 47 prefectures.

While older people are considered at greater risk, the group A strain is leading to more deaths among patients under 50, according to NIID. Of the 65 people under 50 who were diagnosed with STSS between July and December in 2023, about a third, or 21, died, the Asahi Shimbun newspaper reported.

Most cases of STSS are caused by a bacterium called streptococcus pyogenes. More commonly known as strep A – it can cause sore throats, mainly in children, and lots of people have it without knowing it and do not become ill.

But the highly contagious bacteria that cause the infection can, in some cases, cause serious illnesses, health complications and death, particularly in adults over 30. About 30% of STSS cases are fatal.

Older people can experience cold-like symptoms but in rare cases, the symptoms can worsen to include strep throat, tonsillitis, pneumonia and meningitis. In the most serious cases it can lead to organ failure and necrosis.

Some experts believe the rapid rise in cases last year were connected to the lifting of restrictions imposed during the coronavirus pandemic.

In May 2023, the government downgraded Covid-19’s status from class two – which includes tuberculosis and Sars – to class five, placing it on a legal par with seasonal flu. The change meant local authorities were no longer able to order infected people to stay away from work or to recommend hospitalisation.

The move also prompted people to lower their guard, in a country where widespread mask wearing, hand sanitising and avoiding the “three Cs” were credited with keeping Covid-19 deaths comparatively low. About 73,000 Covid-19 deaths were recorded compared with more than 220,000 in Britain, which has a population just over half that of Japan.

Ken Kikuchi, a professor of infectious diseases at Tokyo Women’s Medical University, says he is “very concerned” about the dramatic rise this year in the number of patients with severe invasive streptococcal infections.

He believes the reclassification of Covid-19 was the most important factor behind the increase in streptococcus pyogenes infections. This, he added, had led more people to abandon basic measures to prevent infections, such as regular hand disinfection.

“In my opinion, over 50% Japanese people have been infected by Sars-CoV-2 [the virus that causes Covid-19],” Kikuchi tells the Guardian. “People’s immunological status after recovering from Covid-19 might alter their susceptibility to some microorganisms. We need to clarify the infection cycle of severe invasive streptococcal pyogenes diseases and get them under control immediately.”

Streptococcal infections, like those of Covid-19, are spread through droplets and physical contact. The bacterium can also infect patients through wounds on the hands and feet.

Strep A infections are treated with antibiotics, but patients with the more severe invasive group A streptococcal disease are likely to need a combination of antibiotics and other drugs, along with intensive medical attention.

Japan’s health ministry recommends that people take the same basic hygiene precautions against strep A that became a part of everyday life during the coronavirus pandemic.

“We want people to take preventive steps such as keeping your fingers and hands clean, and exercising cough etiquette,” the health minister, Keizo Takemi, told reporters earlier this year, according to the Japan Times.

• Infectious diseases
• Asia Pacific

Most viewed

• Share full article

Advertisement

Supported by

the new old age

Why Are Older Americans Drinking So Much?

The pandemic played a role in increased consumption, but alcohol use among people 65 and older was climbing even before 2020.

By Paula Span

The phone awakened Doug Nordman at 3 a.m. A surgeon was calling from a hospital in Grand Junction, Colo., where Mr. Nordman’s father had arrived at the emergency room, incoherent and in pain, and then lost consciousness.

At first, the staff had thought he was suffering a heart attack, but a CT scan found that part of his small intestine had been perforated. A surgical team repaired the hole, saving his life, but the surgeon had some questions.

“Was your father an alcoholic?” he asked. The doctors had found Dean Nordman malnourished, his peritoneal cavity “awash with alcohol.”

The younger Mr. Nordman, a military personal finance author living in Oahu, Hawaii, explained that his 77-year-old dad had long been a classic social drinker: a Scotch and water with his wife before dinner, which got topped off during dinner, then another after dinner, and perhaps a nightcap.

Having three to four drinks daily exceeds current dietary guidelines , which define moderate consumption as two drinks a day for men and one for women, or less. But “that was the normal drinking culture of the time,” said Doug Nordman, now 63.

At the time of his 2011 hospitalization, though, Dean Nordman, a retired electrical engineer, was widowed, living alone and developing symptoms of dementia. He got lost while driving, struggled with household chores and complained of a “slipping memory.”

He had waved off his two sons’ offers of help, saying he was fine. During that hospitalization, however, Doug Nordman found hardly any food in his father’s apartment. Worse, reviewing his father’s credit card statements, “I saw recurring charges from the Liquor Barn and realized he was drinking a pint of Scotch a day,” he said.

Public health officials are increasingly alarmed by older Americans’ drinking. The annual number of alcohol-related deaths from 2020 through 2021 exceeded 178,000, according to recently released data from the Centers for Disease Control and Prevention : more deaths than from all drug overdoses combined.

An analysis by the National Institute on Alcohol Abuse and Alcoholism shows that people over 65 accounted for 38 percent of that total. From 1999 to 2020, the 237 percent increase in alcohol-related deaths among those over age 55 was higher than for any age group except 25- to 34-year-olds.

Americans largely fail to recognize the hazards of alcohol, said George Koob, the director of the institute. “Alcohol is a social lubricant when used within the guidelines, but I don’t think they realize that as the dose increases it becomes a toxin,” he said. “And the older population is even less likely to recognize that.”

The growing number of older people accounts for much of the increase in deaths, Dr. Koob said. An aging population foreshadows a continuing surge that has health care providers and elder advocates worried, even if older people’s drinking behavior doesn’t change.

But it has been changing . The proportions of people over 65 who report using alcohol in the past year (about 56 percent) and the past month (about 43 percent) are lower than for all other groups of adults. But older drinkers are markedly more likely to do it frequently, on 20 or more days a month, than younger ones.

Moreover, a 2018 meta-analysis found that binge drinking (defined as four or more drinks on a single occasion for women, five or more for men) had climbed nearly 40 percent among older Americans over the past 10 to 15 years.

What’s going on here?

The pandemic has clearly played a role. The C.D.C. reported that deaths attributable directly to alcohol use, emergency room visits associated with alcohol, and alcohol sales per capita all rose from 2019 to 2020, as Covid arrived and restrictions took hold.

“A lot of stressors impacted us: the isolation, the worries about getting sick,” Dr. Koob said. “They point to people drinking more to cope with that stress.”

Researchers also cite a cohort effect. Compared to those before and after them, “the boomers are a substance-using generation,” said Keith Humphreys, a psychologist and addiction researcher at Stanford. And they’re not abandoning their youthful behavior, he said.

Studies show a narrowing gender divide, too. “Women have been the drivers of change in this age group,” Dr. Humphreys said.

From 1997 to 2014, drinking rose an average of 0.7 percent a year for men over 60, while their binge drinking remained stable. Among older women, drinking climbed by 1.6 percent annually, with binge drinking up 3.7 percent.

“Contrary to stereotypes, upper-middle-class, educated people have higher rates of drinking,” Dr. Humphreys explained. In recent decades, as women grew more educated, they entered workplaces where drinking was normative; they also had more disposable income. “The women retiring now are more likely to drink than their mothers and grandmothers,” he said.

Yet alcohol use packs a greater wallop for older people, especially for women, who become intoxicated more quickly than men because they’re smaller and have fewer of the gut enzymes that metabolize alcohol.

Seniors may argue that they are merely drinking the way they always have, but “equivalent amounts of alcohol have much more disastrous consequences for older adults,” whose bodies cannot process it as quickly, said Dr. David Oslin, a psychiatrist at the University of Pennsylvania and the Veterans Affairs Medical Center in Philadelphia.

“It causes slower thinking, slower reaction time and less cognitive capacity when you’re older,” he said, ticking off the risks.

Long associated with liver diseases, alcohol also “exacerbates cardiovascular disease, renal disease and, if you’ve been drinking for many years, there’s an increase in certain kinds of cancers,” he said. Drinking contributes to falls, a major cause of injury as people age, and disrupts sleep.

Older adults also take a lot of prescription drugs, and alcohol interacts with a long list of them. These interactions can be particularly common with pain medications and sleep aids like benzodiazepines, sometimes causing over-sedation. In other cases, alcohol can reduce a drug’s effectiveness.

Dr. Oslin cautions that, while many prescription bottles carry labels that warn against using those drugs with alcohol, patients may shrug that off, explaining that they take their pills in the morning and don’t drink until evening.

“Those medications are in your system all day long, so when you drink, there’s still that interaction,” he tells them.

One proposal for combating alcohol misuse among older people is to raise the federal tax on alcohol, for the first time in decades. “Alcohol consumption is price-sensitive, and it’s pretty cheap right now relative to income,” Dr. Humphreys said.

Resisting industry lobbying and making alcohol more expensive, the way higher taxes have made cigarettes more expensive, could reduce use.

So could eliminating barriers to treatment. Treatments for excessive alcohol use, including psychotherapy and medications, are no less effective for older patients , Dr. Oslin said. In fact, “age is actually the best predictor of a positive response,” he said, adding that “treatment doesn’t necessarily mean you have to become abstinent. We work with people to moderate their drinking.”

But the 2008 federal law requiring health insurers to provide parity — meaning the same coverage for mental health, including substance use disorders, as for other medical conditions — doesn’t apply to Medicare. Several policy and advocacy groups are working to eliminate such disparities.

Dean Nordman never sought treatment for his drinking, but after his emergency surgery, his sons moved him into a nursing home, where antidepressants and a lack of access to alcohol improved his mood and his sociability. He died in the facility’s memory care unit in 2017.

Doug, whom his father had introduced to beer at 13, had been a heavy drinker himself, he said, “to the point of blackout” as a college student, and a social drinker thereafter.

But as he watched his father decline, “I realized this was ridiculous,” he recalled. Alcohol can exacerbate the progression of cognitive decline, and he had a family history.

He has remained sober since that pre-dawn phone call 13 years ago.

Vaping Health Risks: Study Suggests Nearly 20% Increased Threat Of Heart Disease From E-Cigarette Use

• Share to Facebook
• Share to Twitter
• Share to Linkedin

Vapes containing nicotine may increase the risk of heart failure, according to a new study, adding on to previous research that found vaping may increase the risk of heart disease, worsen blood pressure and heart rate, and cause several lung-related health issues.

woman smokes an electronic cigarette in a public place.

Participants who used e-cigarettes (or vapes) containing nicotine at any point in their lives had a 19% higher chance of developing heart failure compared to those who never used vapes, according to a new study published Tuesday by the American College of Cardiology.

The researchers found the increased risk associated with vaping was more prominent in a type of heart failure called heart failure with preserved ejection fraction (HFpEF), which causes the heart muscle to become stiff and not properly fill with blood between each beat (the research did not find a similar connection to heart failure with reduced ejection fraction, another common form of heart failure).

The researchers tracked 175,667 participants—over 60% female with an average age of 52—over the course of 45 months using health records from the National Institutes of Health.

Of those participants, 3,242 developed heart failure within the 45-month period, and the study found no evidence to suggest other factors—including age, sex or whether they smoked cigarettes—impacted the study.

Crucia Quote

“More and more studies are linking e-cigarettes to harmful effects and finding that it might not be as safe as previously thought,” Yakubu Bene-Alhasan, the study’s lead author and a resident physician at MedStar Health in Baltimore, said in a statement. “We don’t want to wait too long to find out eventually that it might be harmful, and by that time a lot of harm might already have been done.”

6.7 million. That’s how many Americans over the age of 20 had heart failure in 2020, according to a 2023 Journal of Cardiac Failure study . That number is expected to shoot up to 8.5 million by 2030.

Key Background

Because vapes are still fairly new, their long-term effects on the heart haven’t been widely studied, though some research has been done. A 2019 study looked at NIH health data from 2016 and 2017, and couldn’t establish a connection between vaping and heart disease, though it found evidence smoking traditional cigarettes increased the risk of heart disease. Vaping was also not associated with an increased risk of developing heart disease, though dual use of vapes and cigarettes was, a separate 2019 study found. However, researchers in 2022 discovered long-term use of vapes can significantly impair the function of the body’s blood vessels, thus potentially increasing the risk for heart disease. People who vape have negative changes in heart pressure, heartbeat and blood vessel constriction, and also perform worse in exercise tests compared to people who don’t vape, according to 2022 research from the AHA. Vaping is believed to be a healthier alternative to smoking cigarettes. Participants in a 2019 study who smoked cigarettes were switched over to vapes, and most saw improvements in blood pressure and blood vessel stiffness after a month. Although vapes’ aerosols have fewer chemicals than cigarettes, these chemicals—which can include nicotine and heavy metals—are still harmful and may be carcinogenic, according to the Centers for Disease Control and Prevention.

Vaping’s effects on the lungs is more widely studied and known. Vapes produce several dangerous chemicals like formaldehyde, acrolein and acetaldehyde, which can cause lung disease, according to the American Lung Association. Many vapes are flavored using the chemical diacetyl, and research has found it can cause popcorn lung disease. Popcorn lung causes damage to the air sacs in the lungs, resulting in coughing, wheezing, shortness of breath and respiratory failure over time. Over 2,800 vape users were admitted to hospitals with a condition called e-cigarette, or vaping, product use-associated lung injury (EVALI) through February 2020, and 68 died, according to data from the CDC. EVALI can cause shortness of breath, coughing, fever, chills, headaches, rapid heartbeat, chest pain, vomiting and diarrhea.

• Editorial Standards
• Reprints & Permissions

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List

COVID-19 medical papers have fewer women first authors than expected

Jens peter andersen.

1 Danish Centre for Studies in Research and Research Policy, Department of Political Science, Aarhus University, Aarhus, Denmark

Mathias Wullum Nielsen

2 Department of Sociology, University of Copenhagen, Copenhagen, Denmark

Nicole L Simone

3 Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, United States

Resa E Lewiss

4 Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, United States

Reshma Jagsi

5 Department of Radiation Oncology, University of Michigan, Ann Arbor, United States

6 Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, United States

Associated Data

Andersen JP, Nielsen MW. 2020. Inferred gender of COVID-19 researchers per article. Open Science Framework. cpv2m

The final dataset for the main analysis is available on OSF: https://osf.io/cpv2m/ .

The following dataset was generated:

The COVID-19 pandemic has resulted in school closures and distancing requirements that have disrupted both work and family life for many. Concerns exist that these disruptions caused by the pandemic may not have influenced men and women researchers equally. Many medical journals have published papers on the pandemic, which were generated by researchers facing the challenges of these disruptions. Here we report the results of an analysis that compared the gender distribution of authors on 1893 medical papers related to the pandemic with that on papers published in the same journals in 2019, for papers with first authors and last authors from the United States. Using mixed-effects regression models, we estimated that the proportion of COVID-19 papers with a woman first author was 19% lower than that for papers published in the same journals in 2019, while our comparisons for last authors and overall proportion of women authors per paper were inconclusive. A closer examination suggested that women’s representation as first authors of COVID-19 research was particularly low for papers published in March and April 2020. Our findings are consistent with the idea that the research productivity of women, especially early-career women, has been affected more than the research productivity of men.

Introduction

During the COVID-19 pandemic, many governments have shuttered schools and implemented social distancing requirements that limit options for childcare, while simultaneously requiring researchers to work from home ( Minello, 2020 ). Robust evidence suggests that women in academic medicine shoulder more of the burden of domestic labor within their households than do men. One study of an elite sample of NIH-funded physician-researchers showed that women spent 8.5 hr more per week on parenting and domestic tasks than their men peers ( Jolly et al., 2014 ). Recent research also suggests that women in academia take on more domestic responsibilities than men, even in dual-career academic couples ( Derrick et al., 2019 ). Therefore, the recent restrictions in access to childcare might reasonably be expected to have disproportionate impact on women in academic medicine, as compared to men ( Viglione, 2020 ). The impact of new professional service demands that now compete with time for scholarly productivity in academic medicine, including work to increase the use of virtual platforms for teaching and clinical care, may also disproportionately impact women medical researchers, who are disproportionately represented on clinician-educator tracks ( Mayer et al., 2014 ).

Here, we focus on the published medical research literature, where it may be possible to provide an early evaluation of whether the gender gap in academic productivity is widening. The medical literature now includes a substantial number of articles directly relating to COVID-19, mostly generated rapidly after the broader social restrictions came into being, in most US states, in March 2020. We identified 15,839 articles on COVID-19 published between 1 January 2020 and 5 June 2020, including 1893 articles that had a first author and/or last author with an affiliation in the US. Here we report the results of an analysis that compared the proportion of women scientists in various author positions in this sample and a sample of 85,373 papers published in the same journals in 2019 (with first and/or last authors with a US affiliation; see Materials and methods for details).

In Figure 1a–c we juxtapose the observed proportion of women authors (bars) for COVID-19 papers and for papers published in the same journals in 2019. This descriptive analysis suggests that women’s respective share of first authorships (panel a), last authorships (panel b) and overall representation per paper (panel c) is 14%, 3% and 5% lower for COVID-19 papers compared to 2019 papers (COVID-19 sample: first authorships, arithmetic mean = 0.33; last authorships, arithmetic mean: 0.28, overall proportion: 0.33; 2019 sample: first authorships, arithmetic mean = 0.38; last authorships, arithmetic mean: 0.29; overall proportion: arithmetic mean = 0.35).

( a–c ) Observed (bars) and estimated (crosses and error-bars) proportions of women among authors of 1,893 US papers on COVID-19 and 85,373 papers published in the same journals in 2019. The bars show differences in the observed proportions of women in the first-author position ( a ), the last-author position ( b ), and any author position ( c ), for papers published in 2020 COVID-19 papers (blue bars) versus papers from the same journals in 2019 (orange bars). All three panels suggest a decrease in the observed proportion of women. The crosses and error bars show the adjusted means and 95% confidence intervals (CIs) derived from mixed regression models with scientific journal as random effect parameter. ( d–f ) Adjusted means (crosses) and 95% CIs (error bars) derived from mixed regression models for the proportion of women in the first-author position ( d ), last-author position ( e ) and any author position ( f ), for papers published in 2019 (left-most crosses and error bars in each panel), papers published in March and April 2020 (middle), and papers published in May 2020 (right). For all models, there is a drop in March and April, followed by a partial resurgence in May. However, the uncertainty of the estimates make these comparisons inconclusive. See Supplementary file 1 for details of the mixed regression models used to estimate adjusted means and 95% CIs.

The crosses and error-bars in Figure 1a–c plot the adjusted means and 95% confidence intervals derived from three mixed regression models that adjust for variations in COVID-19 related research activities across scientific journals. The plots suggest that women’s estimated share of first authorships, last authorships, and overall proportion per paper is 19%, 5% and 8% lower in the COVID-19 sample (first authorships, adjusted mean = 0.32, CI: 0.28–0.36; last authorships, adjusted mean: 0.26, CI: 0.23–0.30; overall proportion, adjusted mean = 0.36, CI: 0.33–0.30) than in the 2019 sample (first authorships, adjusted mean: 0.40, CI: 0.37–0.42; last authorships, adjusted mean: 0.28, CI: 0.26–0.31; overall proportion, adjusted mean: 0.38, CI: 0.36–0.40) (see Supplementary file 1  for model specifications). However, as indicated by the overlapping confidence intervals in panels b and c, the results are inconclusive for last authorships and for the overall proportion of women per paper.

An earlier iteration of this study ( https://arxiv.org/abs/2005.06303v2 ) based on COVID-19 papers published between 1 January 2020 and 5 May 2020 suggested larger differences than those reported here. Specifically, we found that women's share of first authorships, last authorships and general representation per author group was 23%, 16% and 16% lower for COVID-19 papers compared to 2019 papers published in the same journals. The present analysis covers a larger publication window of COVID-19 research (between 1 January 2020 and 5 June 2020), which has increased the sample from 1,179 US-based COVID-19 papers to 1893 (61% increase). Moreover, the present analysis is restricted to COVID-19 papers authored by US-based first and/or last authors, while the prior analysis included all papers with at least one US-based author. While this difference in sampling criteria might explain part of the observed variation in outcomes, we wanted to examine whether there has been a change over time. In Figure 1d–f we report the estimated proportion of women first authors (panel d), last authors (panel e) and overall representation per paper (panel f), for studies published in 2019 (orange crosshairs), during March and April 2020 (blue crosshairs) and in May 2020 (purple crosshairs). All three models indicate lower participation rates for women in March and April 2020 compared to May 2020, but the uncertainty of the estimates make these results inconclusive. However, panel d shows that the relative difference between women’s proportion of first-authored COVID-19 papers compared to 2019 papers increases to 23%, when the COVID-19 sample is restricted to papers published in March and April 2020.

To obtain a closer approximation of differences across research areas, we calculated the proportion of women authorships per journal specialty. As shown in Table 1 , women are represented at lower rates across most specialty groupings in the COVID-19 sample as compared to the 2019 sample. The relative gap in women’s participation is most salient in infectious diseases, radiology, pathology, and public health. Importantly, none of these groups show extreme deviations from the overall trend. This suggests that the observed differences are not due to a journal-specialty bias, where specialties with a high representation of men produce the majority of COVID-19 research.

Number of observations, N , and proportion of women by author list position for journals grouped by their specialty. The grouped columns show results by journal specialty for COVID papers published in 2020 (four rightmost columns) in contrast to papers from the same journals in 2019. Only papers with a US-based first and/or last author and clear gender for first and last author are included.

Prior research has raised concerns about women’s underrepresentation among authors of medical research, including both original research and commentaries ( Clark et al., 2017 ; Hart and Perlis, 2019 ; Jagsi et al., 2006 ; Larson et al., 2019 ; Silver et al., 2018 ). Our study suggests that the COVID-19 pandemic might have amplified this gender gap in the medical literature. Specifically, we find that women constitute a lower share of first authors of articles on COVID-19, as compared to the proportion of women among first authors of all articles published in the same journals the previous year. However, our analysis also indicates that the first-author gender gap in COVID-19 research might have decreased during the past month of the pandemic. Our findings are consistent with a contemporaneous study of pre-prints ( Vincent-Lamarre et al., 2020 ), which also found women to be under-represented.

Our findings are consistent with the idea that restricted access to child-care and increased work-related service demands might have taken the greatest toll on early-career women, particularly early on when the disruptions were most unexpected, although our observational data cannot conclusively support causal claims. As more robust evidence becomes available, mechanisms which disadvantage specific ethnic, age and gender groups should be monitored and inform policies that promote equity ( Donald, 2020 ).

Some have argued that the authorship gender gap in academic medicine is best explained by a slow pipeline and the historical exclusion of women from medical school enrollment ( Association of American Medical Colleges, 2019 ). However, as time has passed, and women have reached parity in the United States and even begun to constitute the majority of the medical student body in many other countries, their persistently low participation as authors has raised concerns about bias in unblinded peer review processes and unequal opportunities prior to manuscript submission ( Jagsi et al., 2014 ; Silver, 2019 ). Studies have demonstrated differences in the language used by men and women to describe their research findings ( Lerchenmueller et al., 2019 ), and evidence from the field of economics suggests that women’s writing may be held to higher standards ( Hengel, 2017 ). In any case, the current study suggest that if authorship of COVID-19-related papers is a bellwether, women’s participation in the medical research literature may now be facing even greater challenges than before the pandemic ( Kissler et al., 2020 ).

This study is limited to a relatively small sample produced early in the course of the pandemic and misses information on important covariates. A key limitation is that we have not been able to adjust for variations in COVID-19 related research activities across medical research specialties. Since women’s representation as authors varies across specialties ( Andersen et al., 2019 ), this may introduce a bias. We have attempted to mitigate this bias by including scientific journal as random effect parameter in the regression models, hereby adjusting for variations in COVID-19 related research activities across publication outlets. Moreover, descriptive analysis that breaks down our results by journal specialty does not suggest that those journal specialties that might dominate research related to COVID had low proportions of women among authors in 2019. Indeed, many such specialties, including infectious disease and public health, qualitatively appear to have a markedly lower proportion of women among authors in the 2020 COVID-related dataset than in the 2019 dataset within those fields. Nevertheless, future research might refine our analysis by using Medical Subject Headings (MeSH) to infer the research specialty of each paper ( Andersen et al., 2019 ). The US National Library of Medicine usually assign MeSH terms to medical papers within 3–6 months after publication.

Although we were reliably able to determine gender for the vast majority of the first and last authors and a large majority of all authors, bias is possible due to omission of those whose gender could not be determined. There is no difference in the percentage of matched names between the treatment and control groups.

Despite limitations, this early look suggests that the previously documented gender gap in academic medical publishing may warrant renewed attention ( Jagsi et al., 2006 ), and that ongoing research on this subject is necessary as more data become available. The need for greater equity and diversity is most evident in times of crisis. Abundant literature reveals the importance of diverse teams for solving complex problems like those related to COVID-19 ( Mayer et al., 2014 ; Nielsen et al., 2017a ; Nielsen et al., 2018 ; Phillips, 2014 ; Woolley et al., 2010 ). If societal constraints limit the talent pool who may contribute to research informing the crisis response, the consequences will be profound indeed. Policies to support the full inclusion of diverse scholars and transformation of norms for dividing labor appear to be urgent priorities. Policies that merit consideration include providing more teaching support for female faculty or relieving them of teaching duties, supporting child-care costs and identifying child-care options, extending the tenure-clock for the duration of the lockdown, or adjusting the criteria used to assess and select candidates for research funding and tenured positions.

Materials and methods

On 5 June 2020 we searched PubMed Medline for papers including ‘COVID-19’ or ‘SARS-CoV2’ in the title or abstract, to identify publications most likely generated after pandemic-related societal changes developed. This resulted in 15,843 articles, of which only four were published prior to 2020. We extracted journal information and matched the 2020 papers [treatment] to 2019 papers [control] from the same journals ( N  = 316,367). Only journals with at least five papers on COVID-19 were included in the analysis (629 of 2420 journals (25.9%), 12,855 of 15,843 papers (81.1%)). We extracted author names for both treatment and control, and used these to determine author gender as in prior work ( Andersen et al., 2019 ; Nielsen et al., 2017b ). Please see these papers for a clarification of the gender-API algorithm and our robustness checks of gender inference.

Gender was reliably estimated for 90.2% of the entire sample. The majority of insecure inferences are due to Chinese names, which are commonly not gendered ( Andersen et al., 2019 ; Nielsen et al., 2017b ). For the papers with at least one US author, gender could be established for 90.7% of US first authors and 91.7% of US last authors. Only papers with gender reliably identified for first and last authors were included. Limiting the sample further to papers with at first author and/or last author with a US address, with gender determined for authors, gives us a treatment group of 1893 papers (14.7%) and a control group of 85,373 papers (30.0%). The treatment group is relatively smaller, because proportionally more COVID-19 research has been done by researchers outside the US, especially those in China and Italy.

As a robustness check, we selected a random sample of 300 publications from the treatment group and looked up information supplied by the publishers on submission and publication dates. Far from all publishers offer this information and to our knowledge there are no databases gathering this information consistently. Thus, we were able to find submission dates for 153 (51.0%) of the 300 publications. Of these, 129 (84.3%) were submitted after 15 March 2020, and 276 of the 300 (92.0%) were published after this date.

We used mixed logit models with random intercepts and random slopes to estimate the relationship between the dichotomous intervention variable (2019 sample = 0, COVID-19 sample = 1) and (i) women’s share of first authorships (outcome variable: man = 0, woman = 1), (ii) women’s share of last authorships (outcome variable: man = 0, woman = 1), and (iii) women’s overall representation per article (two-vector outcome variable: number of women, number of men; Crawley, 2012 ). We included scientific journal as random effect parameter to adjust for variations in COVID-related research activities across scientific journals.

For the time factor analysis, we used the date of electronic publication (or date of publication, if electronic publication date was not available) from PubMed to create dichotomous variables for COVID-19 studies published in March/April 2020 and May 2020. Following the procedure specified above, we used mixed logit models to estimate the relationship between these time-specific dichotomous variables and the three outcome measures.

The statistical analyses were conducted in R version 4.0.0. For the mixed logit models, we used the ‘lme4’ v. 1.1–23 package in R. We used the ‘emmeans’ v. 1.4.7 package to produce adjusted means and ‘ggplot2’ v. 3.3.0 to produce figures.

To produce Table 1 , we manually categorized journals by specialty. Four authors participated in grouping the journals, with at least two independently coding every journal, and with discrepancies addressed by team consensus.

Biographies

Jens Peter Andersen is in the Danish Centre for Studies in Research and Research Policy, Department of Political Science, Aarhus University, Aarhus, Denmark

Mathias Wullum Nielsen is in the Department of Sociology, University of Copenhagen, Copenhagen, Denmark

Nicole L Simone is in the Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, United States

Resa E Lewiss is in the Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, United States

Reshma Jagsi is in the Department of Radiation Oncology, University of Michigan, Ann Arbor, United States

Funding Statement

No external funding was received for this work.

Contributor Information

Peter Rodgers, eLife, United Kingdom.

Additional information

No competing interests declared.

Founder of TIME'S UP Healthcare, a non-profit initiative that advocates for safety and equity in healthcare; advisor for FeminEM.org, a website that supports the careers of women in medicine.

Has stock options as compensation for her advisory board role in Equity Quotient, a company that evaluates culture in health care companies; has received personal fees from Amgen and Vizient and grants for unrelated work from the National Institutes of Health, the Doris Duke Foundation, the Greenwall Foundation, the Komen Foundation, and Blue Cross Blue Shield of Michigan for the Michigan Radiation Oncology Quality Consortium; has a contract to conduct an investigator-initiated study with Genentech; has served as an expert witness for Sherinian and Hasso and Dressman Benzinger LaVelle; uncompensated founding member of TIME'S UP Healthcare; member of the Board of Directors of ASCO.

Conceptualization, Data curation, Software, Formal analysis, Validation, Investigation, Visualization, Methodology, Writing - original draft, Writing - review and editing.

Conceptualization, Validation, Investigation, Methodology, Writing - original draft, Writing - review and editing.

Conceptualization, Supervision, Validation, Investigation, Methodology, Writing - original draft, Project administration, Writing - review and editing.

Additional files

Supplementary file 1., transparent reporting form, data availability.

• Andersen JP, Schneider JW, Jagsi R, Nielsen MW. Gender variations in citation distributions in medicine are very small and due to self-citation and journal prestige. eLife. 2019; 8 :e45374. doi: 10.7554/eLife.45374. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Association of American Medical Colleges Medical students selected years. 2015. [June 16, 2020]; 2019 https://www.aamc.org/system/files/reports/1/2015table1.pdf
• Clark J, Zuccala E, Horton R. Women in science, medicine, and global health: call for papers. The Lancet. 2017; 390 :2423–2424. doi: 10.1016/S0140-6736(17)32903-3. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Crawley MJ. The R Book. John Wiley & Sons; 2012. [ Google Scholar ]
• Derrick GE, Jaeger A, Chen P-Y, Sugimoto CR, Van Leeuwen TN, Larivière V. Models of parenting and its effect on academic productivity: preliminary results from an international survey. Proceedings of the 17th International Conference on Scientometrics & Infometrics International Society for Informetrics and Scientometrics.2019. [ Google Scholar ]
• Donald A. Yet another source of inequality? Occam’s Typewriter. [June 16, 2020]; 2020 http://occamstypewriter.org/athenedonald/2020/04/27/yet-another-source-of-inequality
• Hart KL, Perlis RH. Trends in proportion of women as authors of medical journal articles, 2008-2018. JAMA Internal Medicine. 2019; 179 :1285. doi: 10.1001/jamainternmed.2019.0907. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Hengel E. Publishing while female. Cambridge Work Pap Econ. 2017; 2019 :1–76. doi: 10.17863/CAM.17548. [ CrossRef ] [ Google Scholar ]
• Jagsi R, Guancial EA, Worobey CC, Henault LE, Chang Y, Starr R, Tarbell NJ, Hylek EM. The "gender gap" in authorship of academic medical literature--a 35-year perspective. New England Journal of Medicine. 2006; 355 :281–287. doi: 10.1056/NEJMsa053910. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Jagsi R, Bennett KE, Griffith KA, DeCastro R, Grace C, Holliday E, Zietman AL. Attitudes toward blinding of peer review and perceptions of efficacy within a small biomedical specialty. International Journal of Radiation Oncology, Biology, Physics. 2014; 89 :940–946. doi: 10.1016/j.ijrobp.2014.04.021. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Jolly S, Griffith KA, DeCastro R, Stewart A, Ubel P, Jagsi R. Gender differences in time spent on parenting and domestic responsibilities by high-achieving young physician-researchers. Annals of Internal Medicine. 2014; 160 :344–353. doi: 10.7326/M13-0974. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kissler SM, Tedijanto C, Goldstein E, Grad YH, Lipsitch M. Projecting the transmission dynamics of SARS-CoV-2 through the postpandemic period. Science. 2020; 368 :860–868. doi: 10.1126/science.abb5793. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Larson AR, Poorman JA, Silver JK. Representation of women among physician authors of perspective-type articles in high-impact dermatology journals. JAMA Dermatology. 2019; 155 :386. doi: 10.1001/jamadermatol.2018.5517. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Lerchenmueller MJ, Sorenson O, Jena AB. Gender differences in how scientists present the importance of their research: observational study. BMJ. 2019; 367 :l6573. doi: 10.1136/bmj.l6573. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Mayer AP, Blair JE, Mg K, Hayes SN, Chang Y-HH, Caubet SL, Files JA. Gender distribution of US medical school faculty by academic track type.  Acad Med. 2014; 89 :312–317. doi: 10.1097/ACM.0000000000000089. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Minello A. The pandemic and the female academic. [April 28, 2020]; Nature. 2020 https://www.nature.com/articles/d41586-020-01135-9 [ PubMed ]
• Nielsen MW, Alegria S, Börjeson L, Etzkowitz H, Falk-Krzesinski HJ, Joshi A, Leahey E, Smith-Doerr L, Woolley AW, Schiebinger L. Gender diversity leads to better science. PNAS. 2017a; 114 :1740–1742. doi: 10.1073/pnas.1700616114. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Nielsen MW, Andersen JP, Schiebinger L, Schneider JW. One and a half million medical papers reveal a link between author gender and attention to gender and sex analysis. Nature Human Behaviour. 2017b; 1 :791–796. doi: 10.1038/s41562-017-0235-x. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Nielsen MW, Bloch CW, Schiebinger L. Making gender diversity work for scientific discovery and innovation. Nature Human Behaviour. 2018; 2 :726–734. doi: 10.1038/s41562-018-0433-1. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Phillips KW. How diversity makes us smarter. Scientific American. 2014; 311 (Oct) :42–47. doi: 10.1038/scientificamerican1014-42. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Silver JK, Poorman JA, Reilly JM, Spector ND, Goldstein R, Zafonte RD. Assessment of women physicians among authors of perspective-type articles published in high-impact pediatric journals. JAMA Network Open. 2018; 1 :e180802. doi: 10.1001/jamanetworkopen.2018.0802. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Silver JK. Medical journals must tackle gender bias: when women doctors and scientists face barriers to publication and journal leadership, the pace of discovery slows and critical perspectives are lost. BMJ. 2019; 367 :1–2. doi: 10.1136/bmj.l5888. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Viglione G. Are women publishing less during the pandemic? Here's what the data say. Nature. 2020; 581 :365–366. doi: 10.1038/d41586-020-01294-9. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Vincent-Lamarre P, Sugimoto CR, Larivière V. The decline of women’s research production during the coronavirus pandemic. [June 16, 2020]; Nature Index. 2020 https://www.natureindex.com/news-blog/decline-women-scientist-research-publishing-production-coronavirus-pandemic
• Woolley AW, Chabris CF, Pentland A, Hashmi N, Malone TW. Evidence for a collective intelligence factor in the performance of human groups. Science. 2010; 330 :686–688. doi: 10.1126/science.1193147. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• eLife. 2020; 9: e58807.

Decision letter

In the interests of transparency, eLife publishes the most substantive revision requests and the accompanying author responses.

Thank you for submitting your article "Meta-Research: Is Covid-19 Amplifying the Authorship Gender Gap in the Medical Literature?" for consideration by eLife . Your article has been reviewed by two peer reviewers, and the evaluation has been overseen by the eLife Features Editor (Peter Rodgers). The reviewers have opted to remain anonymous. Both reviewers were positive about the article, but they raised a small number of concerns that we would like you to address in a revised manuscript.

Reviewer #1: This is an analysis of whether COVID-19 is affecting the gender gap in medical publishing. The authors identify papers published on COVID-19 in 2020 and analyze whether women are underrepresented as first author, last authors or general authorship by comparing their representation in the same journals for all of 2019. They find that women are underrepresented, most strongly in the first author category. Further, this disparity is unlikely to be explained by the underrepresentation of female authors in specific fields that characterize papers published on COVID-19. It's a very clever and convincing analysis but some details need to be clarified.

Essential revisions:

1) The full dataset used in the study (all papers, author names, gender inferences, etc), as well as the code used to analyze the data, need to be made available to allow others to reproduce or expand the analysis.

2) The robustness of author gender determination is not clear, and the methods should be described in more depth. For example, the text states "Gender was reliably estimated for 81.9% of the entire sample": what does "reliably estimated" mean here? How is the accuracy of the gender estimation tool established? What is the likelihood that a given gender was determined correctly? Doing spot checks of a random sample of authors can be helpful. Additionally, adding more information on the specific methods used for inferring gender from author names would be useful.

3) The same issue might lead to bias in the analysis: only 81.9% of authors are included in the study, and these 81.9% represent a biased sample of all authors - those with names that are more common or more recognizable by the gender estimation tool. Thus, the study likely under-represents authors from certain countries, nationalities, and social backgrounds. Is there a way to assess the impact of this bias on the results and analysis? At a minimum, this should be discussed as a caveat.

4) I am not convinced by the authors' argument that the observed differences are not due to a specialty bias. By looking at COVID-19-specific papers only, they are looking at the gender distribution of authors in a specific field, and comparing them to the gender distribution of authors in a variety of other fields who happen to publish in similar journals. It is entirely possible that there is a gender bias in coronavirus research, for example- this would not be captured by journal specialty, but would be seen in gender proportions for COVID-19 papers. Please add additional columns to table 1 looking at all research published in these journals in 2020 (not just COVID-19-related research), and/or discuss at greater length the possibility of specialty bias in your results.

5) The authors limited their samples to papers with at least one US author. It could be useful to know, of the 1179 papers in the treatment group, how many papers had more than one US author? I'm concerned that this limitation may introduce confounding factors. Knowing how many of these papers were published by teams of scientists primarily working in the US, vs a single scientist working in the US with a larger international team, would address this concern and more strongly support the authors' point that the disparity in female authorship can be potentially linked to the social restrictions in the US.

Author response

[We repeat the reviewers’ points here in italic, and include our replies point by point, as well as a description of the changes made, in Roman.]

We want to thank the editor and the reviewers for their excellent comments and suggestions. We have gone over them all and made changes accordingly. Most importantly, some of the comments have caused an update of the data set, which changes some of the findings and allows us to fine-tune the analysis. Since we initially harvested data in April 2020, PubMed has changed its interface and now provides better (and more consistent) information on author affiliations. This allows a much more precise analysis of author country, as requested by one of the reviewers. This was not possible previously.

We address this data update in the paper, in an effort to be as transparent about the process as possible, but for good measure, we would like to mention here the original sample, which was 9,050 COVID-19 papers, of which 1,179 had gender for first and last author, and at least one US-based author. These numbers are now 15,839 and 1,893 respectively. When analyzing first-authors, we restrict to US-based first authors and vice versa for last authors.

Below, we list the comments from the reviewers and editor in italics and our responses in regular font face.

Essential revisions: 1) The full dataset used in the study (all papers, author names, gender inferences, etc), as well as the code used to analyze the data, need to be made available to allow others to reproduce or expand the analysis.

We have uploaded the data and the analytical scripts to OSF. The project is private right now, but we will make it public when/if our paper is published. An R script is provided, which will allow full analysis from the most raw data set we are able to provide (gender is inferred and information from PubMed is extracted into a table).

Checking the correctness of gender assignment is of course important. Our data relies on an algorithm, which we have previously used and checked for robustness. We realize that this was not apparent from the very short comment in the paper, and have added a little more detail about which algorithm we used and that robustness checks have previously been performed.

We have adjusted the method so that we now only compare US first and last authors. We believe this is a strength of the study because it allows us to isolate the effect to a single country and the timing of both disease and social constraints. For the analysis of the full author group, there could potentially be a bias, which we address in the limitations.

While this is certainly an important point, we also have to disagree, for two reasons. COVID-19 specific papers are not from a specific field. On the contrary, the vast majority of medical specialties have picked up research on COVID-19 in one way or another. The search for cures or vaccines are likely limited, but discussions about implications for treatment of other diseases span all of clinical medicine. Secondly, our reason for using COVID-19 research as the “treatment” case was not to look specifically into this, but rather to have a sample of papers where we knew the research would have to be done in 2020. If we introduced a new column of “other” 2020 papers from the same journals, it would be impossible to know which of these had been in the pipeline since 2019 or earlier, and which were actually based on research from 2020.

We hope that the changes to how we analyze first and last authors (analysis of first/last author gender restricted to first/last authors from the US) also addresses this point. For the share of women in the full group, this remains a valid concern, but not one we are currently able to address. While PubMed has now introduced per-author affiliations, it is not realistic to use these to make statistical analyses. When we claim to look only at papers with US-authors, this is really a conservative claim; there are certainly more papers with US addresses, but where the country or state is not included in the affiliation, or included in non-standardized forms. Our database contains more than sixty thousand “countries” from the affiliations, as there is no standard formatting of PubMed affiliations. We have trawled all of these for combinations of “USA”, “United States”, “America”, state names, names of major cities etc., to find the most complete set of affiliations related to the USA. However, we are not able to provide a reliable estimate of the national distribution of affiliations of all authors.

• Feature Article

Meta-Research: COVID-19 medical papers have fewer women first authors than expected

• Jens Peter Andersen
• Mathias Wullum Nielsen
• Nicole L Simone
• Resa E Lewiss

• Danish Centre for Studies in Research and Research Policy, Department of Political Science, Aarhus University, Denmark ;
• Department of Sociology, University of Copenhagen, Denmark ;
• Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, United States ;
• Department of Emergency Medicine, Thomas Jefferson University, United States ;
• Department of Radiation Oncology, University of Michigan, United States ;
• Center for Bioethics and Social Sciences in Medicine, University of Michigan, United States ;
• Open access
• Copyright information
• Comment Open annotations (there are currently 0 annotations on this page).
• 9,599 views
• 276 citations

Share this article

Cite this article.

• Reshma Jagsi
• Copy to clipboard
• Download BibTeX
• Download .RIS
• Figures and data

Introduction

Materials and methods, data availability, decision letter, author response, article and author information.

The COVID-19 pandemic has resulted in school closures and distancing requirements that have disrupted both work and family life for many. Concerns exist that these disruptions caused by the pandemic may not have influenced men and women researchers equally. Many medical journals have published papers on the pandemic, which were generated by researchers facing the challenges of these disruptions. Here we report the results of an analysis that compared the gender distribution of authors on 1893 medical papers related to the pandemic with that on papers published in the same journals in 2019, for papers with first authors and last authors from the United States. Using mixed-effects regression models, we estimated that the proportion of COVID-19 papers with a woman first author was 19% lower than that for papers published in the same journals in 2019, while our comparisons for last authors and overall proportion of women authors per paper were inconclusive. A closer examination suggested that women’s representation as first authors of COVID-19 research was particularly low for papers published in March and April 2020. Our findings are consistent with the idea that the research productivity of women, especially early-career women, has been affected more than the research productivity of men.

During the COVID-19 pandemic, many governments have shuttered schools and implemented social distancing requirements that limit options for childcare, while simultaneously requiring researchers to work from home ( Minello, 2020 ). Robust evidence suggests that women in academic medicine shoulder more of the burden of domestic labor within their households than do men. One study of an elite sample of NIH-funded physician-researchers showed that women spent 8.5 hr more per week on parenting and domestic tasks than their men peers ( Jolly et al., 2014 ). Recent research also suggests that women in academia take on more domestic responsibilities than men, even in dual-career academic couples ( Derrick et al., 2019 ). Therefore, the recent restrictions in access to childcare might reasonably be expected to have disproportionate impact on women in academic medicine, as compared to men ( Viglione, 2020 ). The impact of new professional service demands that now compete with time for scholarly productivity in academic medicine, including work to increase the use of virtual platforms for teaching and clinical care, may also disproportionately impact women medical researchers, who are disproportionately represented on clinician-educator tracks ( Mayer et al., 2014 ).

Here, we focus on the published medical research literature, where it may be possible to provide an early evaluation of whether the gender gap in academic productivity is widening. The medical literature now includes a substantial number of articles directly relating to COVID-19, mostly generated rapidly after the broader social restrictions came into being, in most US states, in March 2020. We identified 15,839 articles on COVID-19 published between 1 January 2020 and 5 June 2020, including 1893 articles that had a first author and/or last author with an affiliation in the US. Here we report the results of an analysis that compared the proportion of women scientists in various author positions in this sample and a sample of 85,373 papers published in the same journals in 2019 (with first and/or last authors with a US affiliation; see Materials and methods for details).

In Figure 1a–c we juxtapose the observed proportion of women authors (bars) for COVID-19 papers and for papers published in the same journals in 2019. This descriptive analysis suggests that women’s respective share of first authorships (panel a), last authorships (panel b) and overall representation per paper (panel c) is 14%, 3% and 5% lower for COVID-19 papers compared to 2019 papers (COVID-19 sample: first authorships, arithmetic mean = 0.33; last authorships, arithmetic mean: 0.28, overall proportion: 0.33; 2019 sample: first authorships, arithmetic mean = 0.38; last authorships, arithmetic mean: 0.29; overall proportion: arithmetic mean = 0.35).

COVID-19 papers have fewer female authors than papers from 2019 published in the same journals.

( a–c ) Observed (bars) and estimated (crosses and error-bars) proportions of women among authors of 1,893 US papers on COVID-19 and 85,373 papers published in the same journals in 2019. The bars show differences in the observed proportions of women in the first-author position ( a ), the last-author position ( b ), and any author position ( c ), for papers published in 2020 COVID-19 papers (blue bars) versus papers from the same journals in 2019 (orange bars). All three panels suggest a decrease in the observed proportion of women. The crosses and error bars show the adjusted means and 95% confidence intervals (CIs) derived from mixed regression models with scientific journal as random effect parameter. ( d–f ) Adjusted means (crosses) and 95% CIs (error bars) derived from mixed regression models for the proportion of women in the first-author position ( d ), last-author position ( e ) and any author position ( f ), for papers published in 2019 (left-most crosses and error bars in each panel), papers published in March and April 2020 (middle), and papers published in May 2020 (right). For all models, there is a drop in March and April, followed by a partial resurgence in May. However, the uncertainty of the estimates make these comparisons inconclusive. See Supplementary file 1 for details of the mixed regression models used to estimate adjusted means and 95% CIs.

The crosses and error-bars in Figure 1a–c plot the adjusted means and 95% confidence intervals derived from three mixed regression models that adjust for variations in COVID-19 related research activities across scientific journals. The plots suggest that women’s estimated share of first authorships, last authorships, and overall proportion per paper is 19%, 5% and 8% lower in the COVID-19 sample (first authorships, adjusted mean = 0.32, CI: 0.28–0.36; last authorships, adjusted mean: 0.26, CI: 0.23–0.30; overall proportion, adjusted mean = 0.36, CI: 0.33–0.30) than in the 2019 sample (first authorships, adjusted mean: 0.40, CI: 0.37–0.42; last authorships, adjusted mean: 0.28, CI: 0.26–0.31; overall proportion, adjusted mean: 0.38, CI: 0.36–0.40) (see Supplementary file 1  for model specifications). However, as indicated by the overlapping confidence intervals in panels b and c, the results are inconclusive for last authorships and for the overall proportion of women per paper.

An earlier iteration of this study ( https://arxiv.org/abs/2005.06303v2 ) based on COVID-19 papers published between 1 January 2020 and 5 May 2020 suggested larger differences than those reported here. Specifically, we found that women's share of first authorships, last authorships and general representation per author group was 23%, 16% and 16% lower for COVID-19 papers compared to 2019 papers published in the same journals. The present analysis covers a larger publication window of COVID-19 research (between 1 January 2020 and 5 June 2020), which has increased the sample from 1,179 US-based COVID-19 papers to 1893 (61% increase). Moreover, the present analysis is restricted to COVID-19 papers authored by US-based first and/or last authors, while the prior analysis included all papers with at least one US-based author. While this difference in sampling criteria might explain part of the observed variation in outcomes, we wanted to examine whether there has been a change over time. In Figure 1d–f we report the estimated proportion of women first authors (panel d), last authors (panel e) and overall representation per paper (panel f), for studies published in 2019 (orange crosshairs), during March and April 2020 (blue crosshairs) and in May 2020 (purple crosshairs). All three models indicate lower participation rates for women in March and April 2020 compared to May 2020, but the uncertainty of the estimates make these results inconclusive. However, panel d shows that the relative difference between women’s proportion of first-authored COVID-19 papers compared to 2019 papers increases to 23%, when the COVID-19 sample is restricted to papers published in March and April 2020.

To obtain a closer approximation of differences across research areas, we calculated the proportion of women authorships per journal specialty. As shown in Table 1 , women are represented at lower rates across most specialty groupings in the COVID-19 sample as compared to the 2019 sample. The relative gap in women’s participation is most salient in infectious diseases, radiology, pathology, and public health. Importantly, none of these groups show extreme deviations from the overall trend. This suggests that the observed differences are not due to a journal-specialty bias, where specialties with a high representation of men produce the majority of COVID-19 research.

Proportion of women authors on 2019 papers and COVID-19 papers by specialty.

Number of observations, N , and proportion of women by author list position for journals grouped by their specialty. The grouped columns show results by journal specialty for COVID papers published in 2020 (four rightmost columns) in contrast to papers from the same journals in 2019. Only papers with a US-based first and/or last author and clear gender for first and last author are included.

Prior research has raised concerns about women’s underrepresentation among authors of medical research, including both original research and commentaries ( Clark et al., 2017 ; Hart and Perlis, 2019 ; Jagsi et al., 2006 ; Larson et al., 2019 ; Silver et al., 2018 ). Our study suggests that the COVID-19 pandemic might have amplified this gender gap in the medical literature. Specifically, we find that women constitute a lower share of first authors of articles on COVID-19, as compared to the proportion of women among first authors of all articles published in the same journals the previous year. However, our analysis also indicates that the first-author gender gap in COVID-19 research might have decreased during the past month of the pandemic. Our findings are consistent with a contemporaneous study of pre-prints ( Vincent-Lamarre et al., 2020 ), which also found women to be under-represented.

Our findings are consistent with the idea that restricted access to child-care and increased work-related service demands might have taken the greatest toll on early-career women, particularly early on when the disruptions were most unexpected, although our observational data cannot conclusively support causal claims. As more robust evidence becomes available, mechanisms which disadvantage specific ethnic, age and gender groups should be monitored and inform policies that promote equity ( Donald, 2020 ).

Some have argued that the authorship gender gap in academic medicine is best explained by a slow pipeline and the historical exclusion of women from medical school enrollment ( Association of American Medical Colleges, 2019 ). However, as time has passed, and women have reached parity in the United States and even begun to constitute the majority of the medical student body in many other countries, their persistently low participation as authors has raised concerns about bias in unblinded peer review processes and unequal opportunities prior to manuscript submission ( Jagsi et al., 2014 ; Silver, 2019 ). Studies have demonstrated differences in the language used by men and women to describe their research findings ( Lerchenmueller et al., 2019 ), and evidence from the field of economics suggests that women’s writing may be held to higher standards ( Hengel, 2017 ). In any case, the current study suggest that if authorship of COVID-19-related papers is a bellwether, women’s participation in the medical research literature may now be facing even greater challenges than before the pandemic ( Kissler et al., 2020 ).

This study is limited to a relatively small sample produced early in the course of the pandemic and misses information on important covariates. A key limitation is that we have not been able to adjust for variations in COVID-19 related research activities across medical research specialties. Since women’s representation as authors varies across specialties ( Andersen et al., 2019 ), this may introduce a bias. We have attempted to mitigate this bias by including scientific journal as random effect parameter in the regression models, hereby adjusting for variations in COVID-19 related research activities across publication outlets. Moreover, descriptive analysis that breaks down our results by journal specialty does not suggest that those journal specialties that might dominate research related to COVID had low proportions of women among authors in 2019. Indeed, many such specialties, including infectious disease and public health, qualitatively appear to have a markedly lower proportion of women among authors in the 2020 COVID-related dataset than in the 2019 dataset within those fields. Nevertheless, future research might refine our analysis by using Medical Subject Headings (MeSH) to infer the research specialty of each paper ( Andersen et al., 2019 ). The US National Library of Medicine usually assign MeSH terms to medical papers within 3–6 months after publication.

Although we were reliably able to determine gender for the vast majority of the first and last authors and a large majority of all authors, bias is possible due to omission of those whose gender could not be determined. There is no difference in the percentage of matched names between the treatment and control groups.

Despite limitations, this early look suggests that the previously documented gender gap in academic medical publishing may warrant renewed attention ( Jagsi et al., 2006 ), and that ongoing research on this subject is necessary as more data become available. The need for greater equity and diversity is most evident in times of crisis. Abundant literature reveals the importance of diverse teams for solving complex problems like those related to COVID-19 ( Mayer et al., 2014 ; Nielsen et al., 2017a ; Nielsen et al., 2018 ; Phillips, 2014 ; Woolley et al., 2010 ). If societal constraints limit the talent pool who may contribute to research informing the crisis response, the consequences will be profound indeed. Policies to support the full inclusion of diverse scholars and transformation of norms for dividing labor appear to be urgent priorities. Policies that merit consideration include providing more teaching support for female faculty or relieving them of teaching duties, supporting child-care costs and identifying child-care options, extending the tenure-clock for the duration of the lockdown, or adjusting the criteria used to assess and select candidates for research funding and tenured positions.

On 5 June 2020 we searched PubMed Medline for papers including ‘COVID-19’ or ‘SARS-CoV2’ in the title or abstract, to identify publications most likely generated after pandemic-related societal changes developed. This resulted in 15,843 articles, of which only four were published prior to 2020. We extracted journal information and matched the 2020 papers [treatment] to 2019 papers [control] from the same journals ( N  = 316,367). Only journals with at least five papers on COVID-19 were included in the analysis (629 of 2420 journals (25.9%), 12,855 of 15,843 papers (81.1%)). We extracted author names for both treatment and control, and used these to determine author gender as in prior work ( Andersen et al., 2019 ; Nielsen et al., 2017b ). Please see these papers for a clarification of the gender-API algorithm and our robustness checks of gender inference.

Gender was reliably estimated for 90.2% of the entire sample. The majority of insecure inferences are due to Chinese names, which are commonly not gendered ( Andersen et al., 2019 ; Nielsen et al., 2017b ). For the papers with at least one US author, gender could be established for 90.7% of US first authors and 91.7% of US last authors. Only papers with gender reliably identified for first and last authors were included. Limiting the sample further to papers with at first author and/or last author with a US address, with gender determined for authors, gives us a treatment group of 1893 papers (14.7%) and a control group of 85,373 papers (30.0%). The treatment group is relatively smaller, because proportionally more COVID-19 research has been done by researchers outside the US, especially those in China and Italy.

As a robustness check, we selected a random sample of 300 publications from the treatment group and looked up information supplied by the publishers on submission and publication dates. Far from all publishers offer this information and to our knowledge there are no databases gathering this information consistently. Thus, we were able to find submission dates for 153 (51.0%) of the 300 publications. Of these, 129 (84.3%) were submitted after 15 March 2020, and 276 of the 300 (92.0%) were published after this date.

We used mixed logit models with random intercepts and random slopes to estimate the relationship between the dichotomous intervention variable (2019 sample = 0, COVID-19 sample = 1) and (i) women’s share of first authorships (outcome variable: man = 0, woman = 1), (ii) women’s share of last authorships (outcome variable: man = 0, woman = 1), and (iii) women’s overall representation per article (two-vector outcome variable: number of women, number of men; Crawley, 2012 ). We included scientific journal as random effect parameter to adjust for variations in COVID-related research activities across scientific journals.

For the time factor analysis, we used the date of electronic publication (or date of publication, if electronic publication date was not available) from PubMed to create dichotomous variables for COVID-19 studies published in March/April 2020 and May 2020. Following the procedure specified above, we used mixed logit models to estimate the relationship between these time-specific dichotomous variables and the three outcome measures.

The statistical analyses were conducted in R version 4.0.0. For the mixed logit models, we used the ‘lme4’ v. 1.1–23 package in R. We used the ‘emmeans’ v. 1.4.7 package to produce adjusted means and ‘ggplot2’ v. 3.3.0 to produce figures.

To produce Table 1 , we manually categorized journals by specialty. Four authors participated in grouping the journals, with at least two independently coding every journal, and with discrepancies addressed by team consensus.

The final dataset for the main analysis is available on OSF: https://osf.io/cpv2m/ .

• Andersen JP
• Schneider JW
• Google Scholar
• Association of American Medical Colleges
• Sugimoto CR
• Van Leeuwen TN
• Larivière V
• Guancial EA
• Griffith KA
• Tedijanto C
• Goldstein E
• Lerchenmueller MJ
• Etzkowitz H
• Falk-Krzesinski HJ
• Smith-Doerr L
• Schiebinger L
• Phillips KW
• Goldstein R
• Vincent-Lamarre P
• Peter Rodgers Senior and Reviewing Editor; eLife, United Kingdom

In the interests of transparency, eLife publishes the most substantive revision requests and the accompanying author responses.

Thank you for submitting your article "Meta-Research: Is Covid-19 Amplifying the Authorship Gender Gap in the Medical Literature?" for consideration by eLife . Your article has been reviewed by two peer reviewers, and the evaluation has been overseen by the eLife Features Editor (Peter Rodgers). The reviewers have opted to remain anonymous. Both reviewers were positive about the article, but they raised a small number of concerns that we would like you to address in a revised manuscript.

Reviewer #1: This is an analysis of whether COVID-19 is affecting the gender gap in medical publishing. The authors identify papers published on COVID-19 in 2020 and analyze whether women are underrepresented as first author, last authors or general authorship by comparing their representation in the same journals for all of 2019. They find that women are underrepresented, most strongly in the first author category. Further, this disparity is unlikely to be explained by the underrepresentation of female authors in specific fields that characterize papers published on COVID-19. It's a very clever and convincing analysis but some details need to be clarified.

Essential revisions:

1) The full dataset used in the study (all papers, author names, gender inferences, etc), as well as the code used to analyze the data, need to be made available to allow others to reproduce or expand the analysis.

2) The robustness of author gender determination is not clear, and the methods should be described in more depth. For example, the text states "Gender was reliably estimated for 81.9% of the entire sample": what does "reliably estimated" mean here? How is the accuracy of the gender estimation tool established? What is the likelihood that a given gender was determined correctly? Doing spot checks of a random sample of authors can be helpful. Additionally, adding more information on the specific methods used for inferring gender from author names would be useful.

3) The same issue might lead to bias in the analysis: only 81.9% of authors are included in the study, and these 81.9% represent a biased sample of all authors - those with names that are more common or more recognizable by the gender estimation tool. Thus, the study likely under-represents authors from certain countries, nationalities, and social backgrounds. Is there a way to assess the impact of this bias on the results and analysis? At a minimum, this should be discussed as a caveat.

4) I am not convinced by the authors' argument that the observed differences are not due to a specialty bias. By looking at COVID-19-specific papers only, they are looking at the gender distribution of authors in a specific field, and comparing them to the gender distribution of authors in a variety of other fields who happen to publish in similar journals. It is entirely possible that there is a gender bias in coronavirus research, for example- this would not be captured by journal specialty, but would be seen in gender proportions for COVID-19 papers. Please add additional columns to table 1 looking at all research published in these journals in 2020 (not just COVID-19-related research), and/or discuss at greater length the possibility of specialty bias in your results.

5) The authors limited their samples to papers with at least one US author. It could be useful to know, of the 1179 papers in the treatment group, how many papers had more than one US author? I'm concerned that this limitation may introduce confounding factors. Knowing how many of these papers were published by teams of scientists primarily working in the US, vs a single scientist working in the US with a larger international team, would address this concern and more strongly support the authors' point that the disparity in female authorship can be potentially linked to the social restrictions in the US.

[We repeat the reviewers’ points here in italic, and include our replies point by point, as well as a description of the changes made, in Roman.]

We want to thank the editor and the reviewers for their excellent comments and suggestions. We have gone over them all and made changes accordingly. Most importantly, some of the comments have caused an update of the data set, which changes some of the findings and allows us to fine-tune the analysis. Since we initially harvested data in April 2020, PubMed has changed its interface and now provides better (and more consistent) information on author affiliations. This allows a much more precise analysis of author country, as requested by one of the reviewers. This was not possible previously.

We address this data update in the paper, in an effort to be as transparent about the process as possible, but for good measure, we would like to mention here the original sample, which was 9,050 COVID-19 papers, of which 1,179 had gender for first and last author, and at least one US-based author. These numbers are now 15,839 and 1,893 respectively. When analyzing first-authors, we restrict to US-based first authors and vice versa for last authors.

Below, we list the comments from the reviewers and editor in italics and our responses in regular font face.

Essential revisions: 1) The full dataset used in the study (all papers, author names, gender inferences, etc), as well as the code used to analyze the data, need to be made available to allow others to reproduce or expand the analysis.

We have uploaded the data and the analytical scripts to OSF. The project is private right now, but we will make it public when/if our paper is published. An R script is provided, which will allow full analysis from the most raw data set we are able to provide (gender is inferred and information from PubMed is extracted into a table).

Checking the correctness of gender assignment is of course important. Our data relies on an algorithm, which we have previously used and checked for robustness. We realize that this was not apparent from the very short comment in the paper, and have added a little more detail about which algorithm we used and that robustness checks have previously been performed.

We have adjusted the method so that we now only compare US first and last authors. We believe this is a strength of the study because it allows us to isolate the effect to a single country and the timing of both disease and social constraints. For the analysis of the full author group, there could potentially be a bias, which we address in the limitations.

While this is certainly an important point, we also have to disagree, for two reasons. COVID-19 specific papers are not from a specific field. On the contrary, the vast majority of medical specialties have picked up research on COVID-19 in one way or another. The search for cures or vaccines are likely limited, but discussions about implications for treatment of other diseases span all of clinical medicine. Secondly, our reason for using COVID-19 research as the “treatment” case was not to look specifically into this, but rather to have a sample of papers where we knew the research would have to be done in 2020. If we introduced a new column of “other” 2020 papers from the same journals, it would be impossible to know which of these had been in the pipeline since 2019 or earlier, and which were actually based on research from 2020.

We hope that the changes to how we analyze first and last authors (analysis of first/last author gender restricted to first/last authors from the US) also addresses this point. For the share of women in the full group, this remains a valid concern, but not one we are currently able to address. While PubMed has now introduced per-author affiliations, it is not realistic to use these to make statistical analyses. When we claim to look only at papers with US-authors, this is really a conservative claim; there are certainly more papers with US addresses, but where the country or state is not included in the affiliation, or included in non-standardized forms. Our database contains more than sixty thousand “countries” from the affiliations, as there is no standard formatting of PubMed affiliations. We have trawled all of these for combinations of “USA”, “United States”, “America”, state names, names of major cities etc., to find the most complete set of affiliations related to the USA. However, we are not able to provide a reliable estimate of the national distribution of affiliations of all authors.

Author details

Jens Peter Andersen is in the Danish Centre for Studies in Research and Research Policy, Department of Political Science, Aarhus University, Aarhus, Denmark

Contribution

Competing interests.

Mathias Wullum Nielsen is in the Department of Sociology, University of Copenhagen, Copenhagen, Denmark

Nicole L Simone is in the Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, United States

Resa E Lewiss is in the Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, United States

Reshma Jagsi is in the Department of Radiation Oncology, University of Michigan, Ann Arbor, United States

For correspondence

No external funding was received for this work.

Publication history

• Received: May 12, 2020
• Accepted: June 12, 2020
• Accepted Manuscript published: June 15, 2020 (version 1)
• Version of Record published: June 19, 2020 (version 2)

© 2020, Andersen et al.

This article is distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use and redistribution provided that the original author and source are credited.

• 9,599 Page views
• 782 Downloads
• 276 Citations

Article citation count generated by polling the highest count across the following sources: Scopus , Crossref , PubMed Central .

Download links

Downloads (link to download the article as pdf).

• Article PDF

Open citations (links to open the citations from this article in various online reference manager services)

Cite this article (links to download the citations from this article in formats compatible with various reference manager tools), categories and tags.

• meta-research
• bibliometrics

Research organism

• Part of Collection

Meta-Research: A Collection of Articles

Further reading.

The study of science itself is a growing field of research.

Equity, Diversity and Inclusion

The research community needs to do more to support scientists from underrepresented groups.

• Neuroscience

The importance of individual beliefs in assessing treatment efficacy

In recent years, there has been debate about the effectiveness of treatments from different fields, such as neurostimulation, neurofeedback, brain training, and pharmacotherapy. This debate has been fuelled by contradictory and nuanced experimental findings. Notably, the effectiveness of a given treatment is commonly evaluated by comparing the effect of the active treatment versus the placebo on human health and/or behaviour. However, this approach neglects the individual’s subjective experience of the type of treatment she or he received in establishing treatment efficacy. Here, we show that individual differences in subjective treatment - the thought of receiving the active or placebo condition during an experiment - can explain variability in outcomes better than the actual treatment. We analysed four independent datasets (N = 387 participants), including clinical patients and healthy adults from different age groups who were exposed to different neurostimulation treatments (transcranial magnetic stimulation: Studies 1 and 2; transcranial direct current stimulation: Studies 3 and 4). Our findings show that the inclusion of subjective treatment can provide a better model fit either alone or in interaction with objective treatment (defined as the condition to which participants are assigned in the experiment). These results demonstrate the significant contribution of subjective experience in explaining the variability of clinical, cognitive, and behavioural outcomes. We advocate for existing and future studies in clinical and non-clinical research to start accounting for participants’ subjective beliefs and their interplay with objective treatment when assessing the efficacy of treatments. This approach will be crucial in providing a more accurate estimation of the treatment effect and its source, allowing the development of effective and reproducible interventions.

Be the first to read new articles from eLife

Doctors can do more to help prevent gun violence, USF paper says

• Sam Ogozalek Times staff

Doctors can do more to help prevent gun violence and offer counseling on firearms safety, according to a review by University of South Florida researchers, including a medical student who survived the 2018 mass shooting at Marjory Stoneman Douglas High School in Parkland.

The review, published in February in the journal Advances in Pediatrics, noted that many doctors believe they should talk to patients about firearms, but often don’t because of time constraints, a lack of training and discomfort with the topic.

In Florida, a law passed in 2011 limited what questions doctors could ask patients about guns. But a federal appeals court found the restrictions to be unconstitutional and struck them down six years later.

The law “had a very chilling effect I think for a lot of providers,” said Cameron Nereim, one of the review’s authors and an assistant professor of pediatrics at USF who focuses on patients ages 12 to 25 in Tampa.

The review noted that the American Medical Association calls gun violence a public health crisis and firearm-related injuries were the leading cause of death for U.S. children in 2020, surpassing motor vehicle crashes.

Doctors can ask patients about whether guns are kept at home and if they are locked, unloaded and separated from ammunition, according to the review.

USF medical student Nikhita Nookala, who survived the shooting at Marjory Stoneman Douglas High School and covered it as a reporter at The Eagle Eye, the school’s student newspaper, contributed to the review.

The Tampa Bay Times spoke with Nereim and Nookala about their work, which was published with two other authors from North Carolina and Texas medical centers.

The interviews have been edited for clarity and length.

What are the major takeaways you hope physicians get from this paper?

Nookala: It’s important to assess patients’ risks and to see if you can do some harm reduction in terms of encouraging safe storage or just telling kids to be careful around guns.

It doesn’t have to be super political. It’s just about children’s safety at the end of the day.

The paper noted some of the major barriers to physicians counseling on firearms safety are the lack of formal training, lack of confidence that patients will follow their recommendations and low perceived self-efficacy. Are there any ways to address that?

Nereim: I think there are. ... One of the things is how do we do a better job of incorporating this into our training, whether that’s while you’re going through your residency program, while you’re going through your medical school, making sure these things are actually being plugged into our curricula.

Keep up with Tampa Bay’s top headlines

Subscribe to our free DayStarter newsletter

You’re all signed up!

Want more of our free, weekly newsletters in your inbox? Let’s get started.

Is there a particular stage of education where you think this would be best emphasized?

Nereim: I think medical school, before students have even differentiated in terms of what specialty or subspecialty they’ll be choosing, that’s a great opportunity to make sure we’re relaying this information.

In school so far, have people talked about gun violence as a public health issue?

Nookala: Everyone acknowledges that it’s become a problem and it’s getting worse. I think a lot of people feel very helpless because it’s something that is hard to bring up.

You’re not accusing someone of “You don’t store your gun safely, you’re putting your child in danger.” ... You want to (tread) the line of “Oh, you have guns in the home, that’s fine, are you storing them safely, are (you) using gun locks?”

It’s just small things that you can remind people, nicely, without discouraging them from coming back.

During routine visits, do you ask patients or patients’ parents whether there are guns in the home, if they are locked, securely unloaded (and) separated from ammunition?

Nereim: Yes, we do.

With the ongoing mental health crisis that’s involving young people ... I think it becomes even more critical that we do our due diligence and we ask those questions about things like firearm ownership ... how ammunition is being stored, what level of training the family members or the kids themselves have in terms of actually using these objects.

How do those conversations normally go for you? Are they difficult?

Nereim: When you’re able to successfully create that nonjudgemental space ... the vast majority of patients and families are really receptive to the questions we’re asking.

Do you ask patients more often than not? Or do you ask their parents?

Nereim: I tend to do both.

Do you ask firearm-related questions in every visit with a patient, or do you only ask them with someone who would be considered high risk?

Nereim: I wouldn’t say we ask it at every visit. I think we’re getting better at making this more a universal thing that we’re screening for, in the same way that 15, 20 years ago we would make sure at every visit we’re asking “Are you wearing your safety helmet if you’re riding your bike? Are you buckling your seat belt if you’re riding in a car?” We’re moving in that direction.

It happens a lot more consistently in these higher-risk situations, so if you have a patient who’s experiencing mood symptoms, depression or maybe even anger, irritability, impulsive behaviors.

(The paper suggested) that physicians can link those at risk of gun violence to other programs that offer support in the community. Do you do that regularly? How common is that?

Nereim: It’s extremely common. ... In the space where I work, probably anywhere from 50 to 70% of patients may have some significant social need. ... A lot of young people confide in me that they’re fearful just to be outside and to be walking in the place where they live because there have been times where they’ve heard gunshots. Or they know there was a shooting that occurred in that same square, that same block.

As you can imagine, when you have these kinds of social needs that manifest over time, there can be pretty major health consequences.

Why is this research important to you?

Nookala: In the aftermath of the (Marjory Stoneman Douglas High School) shooting, the focus was on Parkland, and Parkland became this beacon of gun violence prevention. But the reality is that outside of that one incident, which was horrible, gun violence doesn’t really occur in cities like Parkland every day. It occurs in cities like Tampa every day in marginalized communities. … The focus needs to be shifted back to that.

Training to be a doctor, I wanted to know more about ways you could make changes on an interpersonal level with your patients without being involved in these really political movements that oftentimes (are) just kind of doing nothing or (do) a little something and it gets reversed a few years later. It’s frustrating to watch that.

Nereim: Violence leads to more violence. The only really, truly effective way for us to move forward as a society is we just have to realize that prevention is incredibly important. … I just don’t think we can ignore the role this is playing in the lives of our patients and their families.

Sam Ogozalek is a reporter covering the healthcare system and mental health. He can be reached at [email protected].

MORE FOR YOU

• Advertisement

ONLY AVAILABLE FOR SUBSCRIBERS

The Tampa Bay Times e-Newspaper is a digital replica of the printed paper seven days a week that is available to read on desktop, mobile, and our app for subscribers only. To enjoy the e-Newspaper every day, please subscribe.

• Skip to main content
• Keyboard shortcuts for audio player

• Your Health
• Treatments & Tests
• Health Inc.
• Public Health

TikTok and others change platforms to protect kids. Advocates say it's just a start

Rhitu Chatterjee

Amid growing concern about children's use of social media, the United Kingdom implemented rules designed to keep kids safer and limit their screen time. The U.S. is weighing similar legislation. Matt Cardy/Getty Images hide caption

Amid growing concern about children's use of social media, the United Kingdom implemented rules designed to keep kids safer and limit their screen time. The U.S. is weighing similar legislation.

Social media companies have collectively made nearly 100 tweaks to their platforms to comply with new standards in the United Kingdom to improve online safety for kids. That's according to a new report by the U.S.-based nonprofit Children and Screens: Institute of Digital Media and Child Development .

The U.K.'s Children's Code, or the Age Appropriate Design Code , went into effect in 2020. Social media companies were given a year to comply with the new rules. The changes highlighted in the report are ones that social media companies, including the most popular ones among kids, like TikTok, YouTube, Instagram and Snapchat, have publicized themselves. The changes extend to platforms as they are used in the United States, as well.

The companies are members of the industry group NetChoice , which has been fighting legislation for online safety in the U.S. by filing lawsuits.

The analysis "is a great first step in identifying what changes were required [and] how the companies have started to announce their changes," says Kris Perry, executive director of Children and Screens.

"It's promising that despite the protests of the various platforms, they are actually taking the feedback from [researchers] and, obviously, policymakers," says Mary Alvord , a child and adolescent psychologist and the co-author of a new book, The Action Mindset Workbook for Teens .

'You have blood on your hands,' senator tells Mark Zuckerberg for failing kids online

The design changes addressed four key areas: 1) youth safety and well-being, 2) privacy, security and data management, 3) age-appropriate design and 4) time management.

For example, there were 44 changes across platforms to improve youth safety and well-being. That included Instagram announcing that it would filter comments considered to be bullying . It is also using machine learning to identify bullying in photos. Similarly, YouTube alerts users when their comments are deemed as offensive, and it detects and removes hate speech.

Similarly, for privacy, security and data management, there were 31 changes across platforms. For example, Instagram says it will notify minors when they are interacting with an adult flagged for suspicious behaviors, and it doesn't allow adults to message minors who are more than two years younger than they are.

The report found 11 changes across platforms to improve time management among minors. For example, autoplay is turned off as a default in YouTube Kids. The default setting for the platform also includes regular reminders to turn off, for kids 13 to 17.

"The default settings would make it easier for them to stop using the device," notes Perry.

"From what we know about the brain and what we know about adolescent development, many of these are the right steps to take to try and reduce harms," says Mitch Prinstein , a neuroscientist at the University of North Carolina at Chapel Hill and chief science officer at the American Psychological Association.

"We don't have data yet to show that they, in fact, are successful at making kids feel safe, comfortable and getting benefits from social media," he adds. "But they're the right first steps."

Research also shows how addictive the platforms' designs are, says Perry. And that is particularly bad for kids' brains, which aren't fully developed yet, adds Prinstein.

Shots - Health News

The truth about teens, social media and the mental health crisis.

"When we look at things like the infinite scroll, that's something that's designed to keep users, including children, engaged for as long as possible," Prinstein says. "But we know that that's not OK for kids. We know that kids' brain development is such that they don't have the fully developed ability to stop themselves from impulsive acts and really to regulate their behaviors."

He's also heartened by some other design tweaks highlighted in the report. "I'm very glad to see that there's a focus on removing dangerous or hateful content," he says. "That's paramount. It's important that we're taking down information that teaches kids how to engage in disordered behavior like cutting or anorexia-like behavior."

The report notes that several U.S. states are also pursuing legislation modeled after the U.K.'s Children's Code. In fact, California passed its own Age-Appropriate Design Code last fall, but a federal judge has temporarily blocked it .

At the federal level, the U.S. Senate is soon expected to vote on a historic bipartisan bill called the Kids Online Safety Act , sponsored by Sen. Richard Blumenthal, D-Conn., and Sen. Marsha Blackburn, R-Tenn. The bill would require social media platforms to reduce harm to kids. It's also aiming to "make sure that tech companies are keeping kids' privacy in mind, thinking about ways in which their data can be used," says Prinstein.

But as families wait for lawmakers to pass laws and for social media companies to make changes to their platforms, many are "feeling remarkably helpless," Prinstein says. "It's too big. It's too hard — kids are too attached to these devices."

But parents need to feel empowered to make a difference, he says. "Go out and have conversations with your kids about what they're consuming online and give them an opportunity to feel like they can ask questions along the way." Those conversations can go a long way in improving digital literacy and awareness in kids, so they can use the platforms more safely.

Legislation in the U.S. will likely take a while, he adds. "We don't want kids to suffer in the interim."

• children's mental health
• social media

Proceedings of the 4th International Conference on Culture, Education and Economic Development of Modern Society (ICCESE 2020)