A theory of fiscal policy response to an epidemic.

Governments worldwide have issued massive amounts of debt to inject fiscal stimulus during the COVID-19 pandemic. This paper analyzes fiscal responses to an epidemic, in which interactions at work increase the risk of disease and mortality. Fiscal policies, which are designed to borrow against the future and provide transfers to individuals suffering economic hardship, can facilitate consumption smoothing while reduce hours worked and hence mitigate infections. We examine the optimal fiscal policy and characterize the condition under which fiscal policy improves social welfare. We then extend the model analyzing the static and dynamic pecuniary externalities under scale economies-the decrease in labor supply during the epidemic lowers the contemporaneous average wage rate while enhances the post-epidemic workforce health and productivity. We suggest that fiscal policy may not work effectively unless the government coordinates working time, and the optimal size of public debt is affected by production technology and disease severity and transmissibility.

Effect of ribociclib on productivity losses due to breast cancer in young women in Brazil

ABSTRACT OBJETIVE To evaluate the effect of ribociclib versus endocrine therapy on productivity losses due to advanced breast cancer. METHODS Productivity data from the MONALEESA-7 trial, obtained from the results of the application of the Work Productivity and Activity Impairment (WPAI) questionnaire on progression-free survival state (43-month follow-up), were extrapolated to the 10,936 Brazilian prevalent cases of premenopausal women with hormone receptor positive/human epidermal growth factor receptor 2 negative (HR+/HER2-) breast cancer. Productivity loss was determined by quantifying the economic costs of workforce dropout over time in both treatment arms and by discounting the economic costs of absenteeism and presenteeism from workforce retention. A human capital approach was used. RESULTS Net productivity gains in the ribociclib arm were estimated at USD 4,285,525.00, representing 316,609 added work hours over 43 months and a mean of 2,009 added work weeks per year. CONCLUSIONS The phase III MONALEESA-7 trial productivity results applied to the Brazilian premenopausal prevalent cases of hormone receptor positive/human epidermal growth factor receptor 2 negative (HR+/HER2-) breast cancer showed that treatment with ribociclib + endocrine therapy improves workforce participation compared with endocrine therapy alone in premenopausal women with hormone receptor positive/human epidermal growth factor receptor 2 negative (HR+/HER2-) metastatic breast cancer, with potential economic gains for the Brazilian society.

Inclusão social no capitalismo: uma análise de economia política sobre a pertença individual ao modo de produção capitalista e sua relação com a deficiência / Social inclusion in capitalism: an political economy analisys on individual membership to the capitalist mode of production and its relationship with disability

O que significa "inclusão social"? Nas últimas décadas essa ideia se tornou capaz de conferir uma áurea de sensibilidade aos mais díspares interesses políticos, como se ela, aplicada, trouxesse consigo a panaceia para todas as mazelas sociais. Para explicar a generalização do que chamamos de "noção de inclusão social", começamos investigando a origem do nosso modo de produção e em seguida entramos no que Marx chama de falsa representação/consciência; ou simplesmente "ideologia". Se a falsa representação encobre o funcionamento do social e se a "inclusão social" pode ser uma falsa representação, que social é esse e por que ele precisa ser encoberto? Mostramos como o sistema capitalista depende de uma massa de indivíduos despossuídos (de capital e de meios de produção). Estes, por sua vez, precisam ser adaptados continuamente para fornecerem um tipo de mercadoria essencial ao capital: a força de trabalho. No entanto, os despossuídos enfrentam dois desafios. Primeiro, a um certo nível, o desenvolvimento da técnica leva os setores mais produtivos a requisitarem cada vez menos trabalhadores. Depois, a força de trabalho precisa respeitar um grau social médio de habilidade e intensidade. Somente contratando força de trabalho com grau social próximo ao médio os membros da classe capitalista conseguem extrair o lucro médio do capital. Sabendo que o desenvolvimento técnico torna mais complexa a preparação do fornecedor da força de trabalho, e dele mais se exige, concluímos que a deficiência representa não um conjunto de limitações individuais. Ela representa a situação do grupo mais prejudicado pelo mecanismo de depuração resultante do desenvolvimento das forças produtivas do capital, que só será eliminado pela revolução social. Para sobreviverem, então, resta à maioria dos deficientes no capitalismo buscar proteção estatal ou apoiar-se na caridade privada.

What does "social inclusion" mean? In recent decades, this idea has become capable of giving an aura of sensitivity to the most disparate political interests, as if it, applied, brought with it the panacea for all social ills. To explain the generalization of what we call the "notion of social inclusion", we start by investigating the origin of our mode of production and then we enter what Marx calls false representation/consciousness; or simply "ideology". If false representation covers up the functioning of the social and if "social inclusion" can be a false representation, what social is this and why does it need to be covered up? We show how the capitalist system depends on a mass of dispossessed individuals (capital and means of production). These, in turn, need to be continually adapted to provide a type of commodity essential to capital: labor power. However, the dispossessed face two challenges. First, at a certain level, the development of technique leads the most productive sectors to require fewer and fewer workers. Second, the workforce must respect an average social degree of skill and intensity. Only by hiring a labor force with a social level close to the average can the members of the capitalist class be able to extract the average profit from capital. Knowing that technical development makes the preparation of the workforce supplier more complex, and more is demanded of him, we conclude that the deficiency represents not a set of individual limitations. It represents the situation of the group most affected by the purification mechanism resulting from the development of the productive forces of capital, which will only be eliminated by the social revolution. In order to survive, then, it remains for the majority of the disabled under capitalism to seek state protection or rely on private charity.

The economic impact of rostering junior doctors to triage to assist nursing staff in the early part of the patient journey through the emergency department.

OBJECTIVE: This study aims to determine whether redeploying junior doctors to assist at triage represents good value for money and a good use of finite staffing resources. METHODS: We undertook a cost-minimisation analysis to produce new evidence, from an economic perspective, about the costs associated with reallocating junior doctors in the emergency department. We built a decision-analytic model, using a mix of prospectively collected data, routinely collected administrative databases and hospital costings to furnish the model. To measure the impact of uncertainty on the model's inputs and outputs, probabilistic sensitivity analysis was undertaken, using Monte Carlo simulation. RESULTS: The mean costs for usual care were $27,035 (95% CI $27,016 to $27,054), while the mean costs for the new model of care were $25,474, (95% CI $25,453 to $25,494). As a result, the mean difference was -$1,561 (95% CI -$1,533 to -$1,588), with the new model of care being a less costly approach to managing staffing allocations, in comparison to the usual approach. CONCLUSION: Our study shows that redeploying a junior doctor from the fast-track area of the department to assist at triage provides a modest reduction in cost. Our findings give decision-makers who seek to maximise benefit from their finite budget, support to reallocate personnel within the ED.

Changing Demographics of NIDDK-Funded Physician-Scientists Doing Kidney Research.

BACKGROUND AND OBJECTIVES: Although US physician-scientists have made enormous contributions to biomedical research, this workforce is thought to be getting smaller. However, among kidney researchers, changes have not been fully quantified. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We mined National Institutes of Health RePORTER to explore demographic changes of early-career and established physician and nonphysician principal investigators doing kidney-focused research. We searched for National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)-funded K series and R01 awards focused on the kidney that were active between 1990 and 2020 and determined if their emphasis was basic or clinical science. We then used public databases available on the internet to determine if these funded investigators were physicians or nonphysicians, the year in which they received either their MD (physicians) or their terminal graduate degree (nonphysicians), their sex, and whether they received their terminal degree from a US or international institution. RESULTS: Kidney-focused R01-funded principal investigators are aging, particularly among physicians. Moreover, the relative representation of physicians among both early-career and established principal investigators is falling, particularly among those doing basic science research. In contrast, the number and relative representation of nonphysician-scientists are increasing. There is also greater representation of women and international graduates among physician and nonphysician R01-funded, kidney-focused NIDDK investigators. However, although there are greater numbers of women physician principal investigators doing both basic as well as clinical research, women physician principal investigators are increasingly more likely to do clinical rather than basic science research. CONCLUSIONS: The physician-scientist workforce is increasingly made up of women and international medical graduates. However, the physician-scientist workforce is older and represents a smaller proportion of all principal investigators, particularly among those doing basic science research.

The broader societal impacts of COVID-19 and the growing importance of capturing these in health economic analyses.

AbstractThe rapid spread of the current COVID-19 pandemic has affected societies worldwide, leading to excess mortality, long-lasting health consequences, strained healthcare systems, and additional strains and spillover effects on other sectors outside health (i.e., intersectoral costs and benefits). In this perspective piece, we demonstrate the broader societal impacts of COVID-19 on other sectors outside the health sector and the growing importance of capturing these in health economic analyses. These broader impacts include, for instance, the effects on the labor market and productivity, education, criminal justice, housing, consumption, and environment. The current pandemic highlights the importance of adopting a societal perspective to consider these broader impacts of public health issues and interventions and only omit these where it can be clearly justified as appropriate to do so. Furthermore, we explain how the COVID-19 pandemic exposed and exacerbated existing deep-rooted structural inequalities that contribute to the wider societal impacts of the pandemic.

RN Salaries Hold Steady; LPNs Gain.

Male nurses continue to earn more than female counterparts.

Who is teaching in Chinese primary schools? A profile of the primary education workforce in Chinese county areas.

A teaching workforce with good quality is a key factor in the process of China's rapid development. Although 76% of Chinese pupils are studying at schools within county areas, a general portray of the corresponding teaching workforce is still not clear. This study presents data from a nationally representative survey of primary education teachers in 35 counties of 18 provinces in China. Findings presented include demographic and professional characteristics, living conditions as well as attitudes towards work. Besides, variations among school locations and geographical regions are also examined. The key findings are the followings: 1) Quality of primary school teachers in county areas has been improved regarding education background; 2) Teaching force in village primary schools has an unbalanced age and gender composition; 3) Out-of-field teaching practice is widespread, especially for minor subjects. 4) Primary school teachers perceived relative low salary and low social status.

Assessing the potential impact on health of the UK's future relationship agreement with the EU: analysis of the negotiating positions.

While policy attention is understandably diverted to COVID-19, the end of the UK's post-Brexit 'transition period' remains 31 December 2020. All forms of future EU-UK relationship are worse for health than EU membership, but analysis of the negotiating texts shows some forms are better than others. The likely outcomes involve major negative effects for NHS staffing, funding for health and social care, and capital financing for the NHS; and for UK global leadership and influence. We expect minor negative effects for cross border healthcare (except in Northern Ireland); research collaboration; and data sharing, such as the Early Warning and Response System for health threats. Despite political narratives, the legal texts show that the UK seeks de facto continuity in selected key areas for pharmaceuticals, medical devices, and equipment [including personal protective equipment (PPE)], especially clinical trials, pharmacovigilance, and batch-testing. The UK will be excluded from economies of scale of EU membership, e.g. joint procurement programmes as used recently for PPE. Above all, there is a major risk of reaching an agreement with significant adverse effects for health, without meaningful oversight by or input from the UK Parliament, or other health policy stakeholders.

American Society for Clinical Pathology's 2019 Wage Survey of Medical Laboratories in the United States.

OBJECTIVES: To inform the pathology and laboratory field of the most recent national wage data. Historically, the results of this biennial survey have served as a basis for additional research on laboratory recruitment, retention, education, marketing, certification, and advocacy. METHODS: The 2019 Wage Survey was conducted through collaboration of the American Society for Clinical Pathology (ASCP) Institute of Science, Technology, and Policy in Washington, DC, and the ASCP Board of Certification in Chicago, Illinois. RESULTS: Compared with 2017, results show an overall increase in salaries for most laboratory occupations surveyed except cytogenetic technologists, laboratory information systems personnel, and performance improvement or quality assurance personnel. Geographically, laboratory professionals from urban areas earned more than their rural counterparts. CONCLUSIONS: As retirement rates continue to increase, the field needs to intensify its efforts on recruiting the next generation of laboratory personnel. To do so, the report urged the field to highlight advocacy for better salaries for laboratory personnel at the local and national levels when developing recruitment and retention strategies.

Results of the 2020 AORN Salary and Compensation Survey.

AORN conducted its 18th annual compensation survey for perioperative nurses in June 2020. A multiple regression model was used to examine how several variables, including job title, education level, certification, experience, and geographic region, affect perioperative nurse compensation. Comparisons between the 2020 data and data from previous years are presented. The effects of other forms of compensation (eg, on-call compensation, overtime, bonuses, shift differentials, benefits) on total compensation are also examined. Additional analyses explore the current state of the nursing shortage, sources of job satisfaction and dissatisfaction, and the effects of the Coronavirus Disease 2019 pandemic.

[French national emergency department's crisis: The outcome of a growing gap between health resources and needs?] / Crise nationale des urgences : le résultat d'un déséquilibre croissant entre offre et demande de soins ?

Overcrowding in Emergency Departments is often considered as an outcome of insufficient access to hospital beds or primary care, therefore a potential lack of health resources. We sought to describe the quantitative evolution of health resources in the French health care system, in comparison with demographic and epidemiologic parameters that reflect health needs. Overall, in the last decade, parameters of capacity and human resources stagnated while activity and spending increased jointly, stimulated by ageing of the population and chronic diseases mostly. Nevertheless, recent official previsions have again recommended to proceed with hospital bed reduction until 2030. This has led to a dangerous saturation of emergency care and to the ongoing systemic health crisis. This situation will require ambitious health resources reinforcement plans in both hospital and primary care. Furthermore, ageing of the population and chronic diseases must lead society to deliberate on the fundamental goals and funding of our health care system.

Global Fund financing and human resources for health investments in the Eastern Mediterranean Region.

BACKGROUND: Despite the large investments in donor-related health activities in areas of the globe prone to tension and conflict, few studies have examined in detail the role of these donor investments in human resources for health (HRH). METHODS: We used a mixed-methods research methodology comprising both quantitative and qualitative analyses to analyze the Enhanced Financial Reporting System of the Global Fund to Fight AIDS, Tuberculosis and Malaria budget and expenditure data from 2003 to 2017 for 13 countries in the Eastern Mediterranean Region (EMR). We analyzed additional detailed budgetary data over the period 2015-2017 for a sub-set of these countries. Two country-case studies were conducted in Afghanistan and Sudan for a more in-depth understanding of the HRH-related activities that occurred as a result of Global Fund grants. RESULTS: The results show that US$2.2 billion Global Fund dollars had been budgeted and US$1.6 billion were expended over the period 2003-2017 in 13 Eastern Mediterranean countries. The average expenditures for human resources for health (training and human resources) as a percentage of total expenditure are 28%. Additional detailed budgetary data analysis shows a more conservative investment in HRH with 13% of total budgets allocated to "direct" HRH activities such as salaries, training costs, and technical assistance. HRH-related activities supported by the Global Fund in Afghanistan and Sudan were similar, including pre-service and in-services training, hiring of program coordinators and staff, and top-ups for clinical staff. CONCLUSIONS: HRH remains a key issue in strengthening the health systems of low- and middle-income countries. While this study suggests that Global Fund's HRH investments in the EMR are not lagging behind the global average, there appears to be a need to further scale up these investments considering this region's unique HRH challenges.

Cost-effectiveness analysis of VECTOS software for the control of diseases transmitted by Aedes aegypti in two Colombian municipalities / [Análisis de costo-efectividad del uso del programa VECTOS en el control rutinario de enfermedades transmitidas por Aedes aegypti en dos municipios de Santander, Colombia].

Introduction: Diseases transmitted by Aedes aegypti are considered a public health problem. VECTOS is a novel software for the integration of vector control strategies. Objective: To assess the cost-effectiveness of the use of VECTOS in the routine control programs of diseases transmitted by A. aegypti in the municipality of San Juan de Girón (Santander). Materials and methods: We conducted a cost-effectiveness analysis using a decision analysis model from the perspective of the local health authorities. We considered the use of the VECTOS software in the routine control activities in the municipality of San Juan de Girón during 2016 as the treatment group while the routine control in the municipality of Floridablanca, where VECTOS is not implemented, was considered as the comparator. We calculated the incremental cost-effectiveness ratio (ICER) taking as effectiveness measure the disability-adjusted life years (DALY). Results: VECTOS was cost-effective at a rate of USD$ 660,4 savings per each DALY avoided compared to the routine control in Floridablanca. The probabilistic model showed that the system was cost-effective in 70% of the 10.000 iterations for a threshold between 1 to 3 GDP per capita. Conclusions: VECTOS software as implemented in the municipality of San Juan de Girón is highly cost-effective and could be used in other municipalities in the country where diseases transmitted by A. aegypti are endemic.

Introducción. Las enfermedades transmitidas por Aedes aegypti son un problema de salud pública. VECTOS es un programa novedoso de integración de estrategias de control de vectores. Objetivo. Evaluar el costo-efectividad del uso del VECTOS en los programas de control rutinario de enfermedades transmitidas por el vector Aedes aegypti en el municipio de San Juan de Girón (Santander). Materiales y métodos. Se evaluó el costo-efectividad del programa empleando un modelo de análisis de decisiones desde la perspectiva de las autoridades locales de salud. Se estudió la integración de las estrategias de control de vectores mediante el programa VECTOS utilizado en el municipio de San Juan de Girón durante el 2016, con el control rutinario llevado a cabo sin VECTOS en el municipio de Floridablanca. Se calculó la razón incremental del costo-efectividad (RICE), usando como medida de efectividad los años de vida ajustados por discapacidad (AVAD). Resultados. El uso del programa VECTOS fue rentable a una tasa de ahorro de USD$660,4 por cada AVAD evitado en comparación con el control de rutina en Floridablanca. El modelo probabilístico indicó que el sistema fue costo-efectivo en el 70 % de las 10.000 iteraciones para un umbral entre 1 y 3 PIB per cápita. Conclusiones. El programa VECTOS fue muy costo-efectivo en el municipio de San Juan de Girón. Su uso puede adoptarse en otros municipios del país donde las enfermedades transmitidas por A. aegypti son endémicas.

Implementation of breast cancer continuum of care in low- and middle-income countries during the COVID-19 pandemic.

Breast cancer is the most common malignancy among women worldwide. The current COVID-19 pandemic represents an unprecedented challenge leading to care disruption, which is more severe in low- and middle-income countries (LMIC) due to existing economic obstacles. This review presents the global perspective and preparedness plans for breast cancer continuum of care amid the COVID-19 outbreak and discusses challenges faced by LMIC in implementing these strategies. Prioritization and triage of breast cancer patients in a multidisciplinary team setting are of paramount importance. Deescalation of systemic and radiation therapy can be utilized safely in selected clinical scenarios. The presence of a framework and resource-adapted recommendations exploiting available evidence-based data with judicious personalized use of current resources is essential for breast cancer care in LMIC during the COVID-19 pandemic.

Emerging Trends in the Neurosurgical Workforce of Low- and Middle-Income Countries: A Cross-Sectional Study.

BACKGROUND: Every year, there are an estimated 22.6 million new neurosurgical consultative cases worldwide, of which 13.8 million require surgery. In 2016, the global neurosurgical workforce was estimated and mapped as open-access information to guide neurosurgeons, affiliates, and policy makers. We present a subsequent investigation for mapping the global neurosurgical workforce for 2018 to show the replicability of previous data collection methods as well as to show any changes in workforce density. METHODS: We extracted data on the absolute number of neurosurgeons per low and middle-income countries (LMICs) in 2016 from the database of the global neurosurgical workforce mapping project. The estimated number of neurosurgeons in each LMIC during 2018 was obtained from collaborators. The median workforce densities were calculated for 2016 and 2018. Neurosurgical workforce density heat maps were generated. RESULTS: We received data from 119 countries (response rate 86.2%) and imputed data for 19 countries (13.8%). Seventy-eight (56.5%, N = 138) countries had an increase in their number of neurosurgeons, 9 (6.5%) showed a decrease, whereas 51 (37.0%) had the same number of neurosurgeons in both years. The pooled median increased from 0.17 (interquartile range, 0.54) in 2016 to 0.18 (interquartile range, 0.59) in 2018. CONCLUSIONS: Overall, the density of the neurosurgical workforce has increased from 2016 to 2018. However, at the current rate, 80 LMICs (58.0%) will not meet the neurosurgical workforce density target by 2030.