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2.
J Shoulder Elbow Surg ; 29(1): 121-125, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31668501

RESUMO

BACKGROUND: The economic loss following ulnar collateral ligament reconstruction (UCLR) in Major League Baseball (MLB) pitchers has not been evaluated. The purpose of this study is to quantify the financial impact of UCLR on MLB teams. We hypothesize that MLB teams incur significant losses annually as a result of salaries paid to injured players following reconstruction. METHODS: Public records were accessed to identify MLB pitchers from January 1, 2004, to December 31, 2014, who had undergone UCLR. Contract terms and time away from competition were used to approximate economic loss. Successful return was considered when a pitcher returned to play in at least 1 Minor League Baseball (MiLB) or MLB game. RESULTS: One hundred ninety-four MLB pitchers underwent UCLR from 2004 to 2014, missing on average 180.2 days of the MLB regular season. Cost of recovery (COR) amounted to $395 million, averaging $1.9 million per player. Starting pitchers accounted for the largest total COR at $239.6 million, whereas closers had the largest economic loss per player ($3.9 million/player). Only 77% of pitchers returned to MLB play. CONCLUSION: UCLR has a substantial economic impact on MLB teams. Starting pitchers represented a majority of team cost, but closers represented higher costs per pitcher.


Assuntos
Beisebol/economia , Ligamento Colateral Ulnar/lesões , Traumatismos Ocupacionais/economia , Salários e Benefícios/economia , Reconstrução do Ligamento Colateral Ulnar/economia , Adulto , Beisebol/lesões , Contratos , Custos e Análise de Custo , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos Ocupacionais/cirurgia , Ocupações/economia , Volta ao Esporte/estatística & dados numéricos , Salários e Benefícios/estatística & dados numéricos , Fatores de Tempo , Adulto Jovem
3.
Fam Med ; 51(6): 489-492, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31184762

RESUMO

BACKGROUND AND OBJECTIVES: Faculty vacancies are a concern for chairs of academic family medicine departments who regularly face having to recruit new faculty. Faculty physicians who report lack of support for research and teaching or excessive time in activities that are not meaningful may experience burnout resulting in leaving academic medicine. METHODS: Data were collected via a Council of Academic Family Medicine Educational Research Alliance (CERA) survey of US family medicine department chairs. To determine characteristics associated with success in hiring new physician faculty, chairs answered questions about the number of vacancies in the previous 12 months, the number of vacancies filled in the previous 12 months, the months the longest vacancy was open, starting salary, whether signing bonus was offered, and the full-time equivalent (FTE) for clinical, research, teaching, and administrative time. RESULTS: The response rate was 52%. Chairs reported an average of 3.9 vacancies in the previous 12 months, and an average of 2.5 (66%) were filled. Chairs who didn't offer protected time for teaching filled a higher percentage of their vacancies, but they did not fill them faster than departments that did offer teaching time. Higher salary and a signing bonus were associated with filling positions faster. Chairs who offered a signing bonus filled positions nearly 4 months sooner than those who didn't. CONCLUSIONS: Offering protected time for teaching or research and FTE allocation for clinical, teaching, research, and administrative time were not associated with success in hiring new faculty. Chairs who offered higher salaries and signing bonuses were able to hire faculty more quickly than those who didn't.


Assuntos
Centros Médicos Acadêmicos/organização & administração , Docentes de Medicina/estatística & dados numéricos , Medicina de Família e Comunidade , Seleção de Pessoal/estatística & dados numéricos , Salários e Benefícios/economia , Esgotamento Profissional/psicologia , Humanos , Inquéritos e Questionários , Estados Unidos
4.
Neurology ; 93(1): 30-34, 2019 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-31101740

RESUMO

In the current medical climate, medical education is at risk of being de-emphasized, leading to less financial support and compensation for faculty. A rise in compensation plans that reward clinical or research productivity fails to incentivize and threatens to erode the educational missions of our academic institutions. Aligning compensation with the all-encompassing mission of academic centers can lead to increased faculty well-being, clinical productivity, and scholarship. An anonymous survey developed by members of the A.B. Baker Section on Neurologic Education was sent to the 133 chairs of neurology to assess the type of compensation faculty receive for teaching efforts. Seventy responses were received, with 59 being from chairs. Key results include the following: 36% of departments offered direct compensation; 36% did not; residency program directors received the most salary support at 36.5% full-time equivalent; and administrative roles had greatest weight in determining academic compensation. We believe a more effective, transparent system of recording and rewarding faculty for their educational efforts would encourage faculty to teach, streamline promotions for clinical educators, and strengthen undergraduate and graduate education in neurology.


Assuntos
Docentes de Medicina/economia , Neurologia/economia , Neurologia/educação , Educação Médica/economia , Humanos , Salários e Benefícios/economia , Inquéritos e Questionários , Estados Unidos
6.
Qual Life Res ; 28(7): 1835-1847, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31030364

RESUMO

PURPOSE: The US does not have universal paid family and medical leave. We examine the direct effects of access to paid leave on patient-reported health, quality of life (QOL), and perceived stress of employed patients who underwent bone marrow transplantation (BMT) to treat advanced blood cancer as well as the indirect effects through reductions in the financial burden (FB) that patients face. METHODS: Our cross-sectional observational study took place at three US transplantation centers in 2014 and 2015. All English-speaking cancer patients 6-month post-BMT were mailed a 43-item survey assessing financial situation, employer benefits, and patient-reported health outcomes. The sample includes the 171 respondents who were employed at the time of BMT. RESULTS: Seemingly unrelated regression analysis confirms that patient access to paid leave was associated with reductions in all three measures of FB, and lower levels of financial hardship were related with improved health, QOL, and perceived stress outcomes. For self-reported health and perceived stress outcomes, all of the effects of patient paid leave operate indirectly through reductions in FB. For QOL outcomes, there is both a direct effect (over 80%) of paid leave and an indirect effect through reduction of FB. CONCLUSION: We found that paid leave affected health outcomes for BMT patients mostly through alleviating FB. These findings suggest universal paid leave policies in the US might alleviate financial hardship and have positive effects on the self-reported QOL of employed patients facing intensive medical treatments.


Assuntos
Transplante de Medula Óssea/economia , Transplante de Medula Óssea/psicologia , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida/psicologia , Salários e Benefícios/economia , Adulto , Estudos Transversais , Emprego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/terapia , Análise de Regressão , Salários e Benefícios/estatística & dados numéricos , Inquéritos e Questionários
7.
Brachytherapy ; 18(4): 445-452, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30992185

RESUMO

PURPOSE: The purpose of this study was to quantify the cost of resources required to deliver adjuvant radiation therapy (RT) for high- to intermediate-risk endometrial cancer using time-driven activity-based costing (TDABC). METHODS AND MATERIALS: Comparisons were made for three and five fractions of vaginal cuff brachytherapy (VCB), 28 fractions of intensity-modulated radiation therapy (IMRT), and combined modality RT (25-fraction IMRT followed by 2-fraction VCB). Process maps were developed representing each phase of care. Salary and equipment costs were obtained to derive capacity cost rates, which were multiplied by process times and summed to calculate total costs. Costs were compared with 2018 Medicare physician fee schedule reimbursement. RESULTS: Full cycle costs for 5-fraction VCB, IMRT, and combined modality RT were 42%, 61%, and 93% higher, respectively, than for 3-fraction VCB. Differences were attributable to course duration and number of fractions/visits. Accumulation of cost throughout the cycle was steeper for VCB, rising rapidly within a shorter time frame. Personnel cost was the greatest driver for all modalities, constituting 76% and 71% of costs for IMRT and VCB, respectively, with VCB requiring 74% more physicist time. Total reimbursement for 5-fraction VCB was 40% higher than for 3-fractions. Professional reimbursement for IMRT was 31% higher than for 5-fraction VCB, vs. IMRT requiring 43% more physician TDABC than 5-fraction VCB. CONCLUSIONS: TDABC is a feasible methodology to quantify the cost of resources required for delivery of adjuvant IMRT and brachytherapy and produces directionally accurate costing data as compared with reimbursement calculations. Such data can inform institution-specific financial analyses, resource allocation, and operational workflows.


Assuntos
Braquiterapia/economia , Neoplasias do Endométrio/radioterapia , Custos de Cuidados de Saúde/estatística & dados numéricos , Instalações de Saúde/economia , Recursos em Saúde/economia , Radioterapia de Intensidade Modulada/economia , Braquiterapia/métodos , Braquiterapia/estatística & dados numéricos , Fracionamento da Dose de Radiação , Equipamentos e Provisões/economia , Feminino , Recursos em Saúde/estatística & dados numéricos , Humanos , Reembolso de Seguro de Saúde/estatística & dados numéricos , Medicare/economia , Radioterapia Adjuvante/economia , Radioterapia Adjuvante/métodos , Radioterapia Adjuvante/estatística & dados numéricos , Radioterapia de Intensidade Modulada/métodos , Radioterapia de Intensidade Modulada/estatística & dados numéricos , Salários e Benefícios/economia , Estados Unidos
8.
Phys Ther ; 99(8): 977-988, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-30939197

RESUMO

BACKGROUND: In Brazil, the number of physical therapy education programs and, consequently, of professionals has been growing for the past 20 years. OBJECTIVES: The objective of the study was to describe the evolution and distribution of physical therapist education programs in Brazil and to analyze the impact of workforce growth on the labor market for these professionals. DESIGN: This was a descriptive, exploratory, quantitative study. METHODS: Secondary data collected from official sources in Brazil were used. RESULTS: The first physical therapist education program was created in 1958, and, after significant growth, 536 programs were active in 2014. The historical series (1996-2014) shows a corresponding increase in the number of admissions by higher educational institutions. This expansion resulted in an increase in the number of professionals, with an impact on the labor market. The workforce in physical therapy is predominantly female, and women increased their participation in this labor market from 59% in 1996 to 81% in 2014. An increase in nominal monthly salaries was observed over the years from US $797.00 in 1996 to US $1056.00 in 2014. Nevertheless, the real average salaries, that is, salaries adjusted to inflation, have followed a trend of devaluation. LIMITATIONS: Results of this study must be interpreted in terms of overall trends rather than as precise absolute numbers due to the inherent nature of the varied secondary data sources. CONCLUSIONS: These data can support further discussion on training and the labor market in the field of physical therapy.


Assuntos
Emprego/economia , Fisioterapeutas/educação , Salários e Benefícios/economia , Brasil , Educação de Pós-Graduação/organização & administração , Feminino , Humanos , Fisioterapeutas/provisão & distribução
9.
Fertil Steril ; 111(6): 1194-1200, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30922655

RESUMO

OBJECTIVE: To determine whether and by how much pay among board-certified or -eligible reproductive endocrinology and infertility (REI) subspecialists in the United States differs by gender. DESIGN: Cross-sectional Web-based survey. SETTING: Not applicable. PATIENT(S): None. INTERVENTION(S): Not applicable. MAIN OUTCOME MEASURE(S): The primary outcome measure was continuous income, which was calculated using the mid-point of salary and bonuses as reported in the survey. Secondary outcomes included income based on type of practice, years in practice, region of the country in practice, and race/ethnicity of survey respondent. RESULT(S): Among 215 responses, 49% were female and 95% were full Society for Reproductive Endocrinology and Infertility members. Fewer women reported being in private practice than men (45% vs. 64%). Female gender was associated with an income gap of 27% in unadjusted comparisons. When adjusted for years in practice and type of practice (private vs. other), the gap diminished to 21% but remained significant, with men reporting higher incomes than women. CONCLUSION(S): The gender pay gap present among physicians and obstetricians and gynecologists more widely persists among REI subspecialists even when accounting for characteristics related to differences in pay. Acknowledging the pay gap among REI subspecialists is the first step in working toward gender-neutral compensation for equivalent work.


Assuntos
Endocrinologistas/economia , Médicas/economia , Medicina Reprodutiva/economia , Salários e Benefícios/economia , Sexismo/economia , Especialização/economia , Mulheres Trabalhadoras , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
10.
PLoS One ; 14(3): e0214234, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30913257

RESUMO

OBJECTIVE: The goal of this study was to analyze differences in the employment and wage trajectories of college-educated young workers in the United States, as distinguished by the timing of their entry into the labor market relative to the onset of the 2008-09 recession. METHODS AND FINDINGS: Using annual American Community Survey microdata, we analyzed the first six years of employment and wage outcomes for cohorts of young workers on traditional-student pathways entering the market (1) in 2006, shortly before recession onset; (2) in 2009, during the recession; and (3) in 2012, three years after the recession officially ended. We found evidence for negative effects on outcomes and outcome trajectories differentiated by the recession's proximity to workers' labor market entry, including lower wages for the cohort entering in 2009. However, recession effects tended to be smaller for workers at the high end of the education gradient or with no direct exposure to the recession and were outweighed by gendered labor outcome disparities. We also observed a possibly enduring, recession-induced rise in the number of idle young males and the proportion of male and female high school graduates enrolled in college and not working. CONCLUSIONS: Cohort differences in labor outcomes show that the disadvantages of entering the labor market during an economic downturn appear lasting. However, the subordinate role of timing effects in sorting young workers' employment and wage rates, when compared to the stark stratification of employment and wage outcomes by education or sex, is a useful reminder that these latter social structures remain key determinants of labor outcomes.


Assuntos
Emprego/economia , Salários e Benefícios/economia , Classe Social , Adulto , Feminino , Humanos , Masculino , Fatores Socioeconômicos , Estados Unidos , Adulto Jovem
11.
Ann Otol Rhinol Laryngol ; 128(5): 401-405, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30739476

RESUMO

OBJECTIVE: Multidisciplinary vascular anomaly clinics (VACs) offer important value to pediatric patients with complex vascular anomalies whose care overlaps specialties. These clinics are labor intensive and costly to operate since providers see fewer patients compared to their individual specialty clinic. Our North American tertiary care institution's VAC specialists include a pediatric otolaryngologist, pediatric surgeon, pediatric plastic surgeon, pediatric dermatologist, and interventional radiologist. To assess financial feasibility, we conducted a cost analysis of our VACs comprised of 2 half-day multidisciplinary physician attended clinics (5 specialists at our main campus and 2 specialists at a satellite clinic) and a half-day nurse practitioner clinic. METHOD: Assessment of net revenue based on net collections for clinic, professional, operative, hospital setting, and facility charges generated during 12 consecutive monthly VACs beginning July 1, 2015. Expense calculations included provider and staff salaries, benefits, supply costs, and clinic leasing costs. RESULTS: There were 469 clinic visits, of which 202 were new patient evaluations. Sixty-eight patients underwent 93 procedures under general anesthesia, including procedures performed by our interventional radiologist, most commonly sclerotherapy or embolization (n = 37), surgical interventions including endoscopy (n = 36), or laser procedures (n = 20). Three patients were admitted. Fifty-seven patients received a new diagnosis different from that for which they were referred. Gross revenue was $1 810 525, and net revenue was 42.5%, or $783 152. Expenses totaled $453 415 for a net positive revenue of $329 737. CONCLUSION: When including direct downstream revenue, particularly from operative procedures, our VAC program operates on a net positive margin, making the program financially feasible.


Assuntos
Instituições de Assistência Ambulatorial/economia , Malformações Vasculares/terapia , Anestesia Geral/estatística & dados numéricos , Custos e Análise de Custo , Embolização Terapêutica/economia , Embolização Terapêutica/estatística & dados numéricos , Endoscopia/economia , Endoscopia/estatística & dados numéricos , Estudos de Viabilidade , Pessoal de Saúde/economia , Humanos , Terapia a Laser/economia , Terapia a Laser/estatística & dados numéricos , América do Norte , Admissão do Paciente/economia , Admissão do Paciente/estatística & dados numéricos , Pediatria , Mecanismo de Reembolso , Estudos Retrospectivos , Salários e Benefícios/economia , Escleroterapia/economia , Escleroterapia/estatística & dados numéricos
15.
Orv Hetil ; 160(2): 50-56, 2019 Jan.
Artigo em Húngaro | MEDLINE | ID: mdl-30616370

RESUMO

There is no nation in the developed world without dysfunctions of its health care system. The cause behind is universal since it goes back to the historic conflict of private and public financing of services. Phenomena on the surface are multi-faceted, in Hungary they are concentrated in the doctors' informal payment the original pattern of which was emerging three centuries ago. While neglecting our series of mismanagement, all our new initiatives will disable any real solution. The world's best health system models in Germany and the United Kingdom function without informal payment. Their substantial models compromise private and public financing. Instead of questionable ideas, Hungary needs to find its own relevant solution based on a new deal with the society but it must have a firm base of scientific evidences. Orv Hetil. 2019; 160(2): 50-56.


Assuntos
Medicina de Família e Comunidade/economia , Planos de Pagamento por Serviço Prestado/economia , Planos de Incentivos Médicos/economia , Salários e Benefícios/economia , Financiamento Pessoal/estatística & dados numéricos , Reforma dos Serviços de Saúde , Acesso aos Serviços de Saúde/economia , Humanos , Hungria , Sociologia Médica
16.
Artigo em Inglês | MEDLINE | ID: mdl-30609676

RESUMO

Objective: To examine the effects of increasing minimum wage on supermarket food prices in Seattle over 2 years of policy implementation, overall and differentially across food quality metrics. Methods: Prices for the UW Center for Public Health Nutrition (CPHN) market basket of 106 foods were obtained for 6 large supermarket chain stores in Seattle ("intervention") and for the same chain stores in King County ("control") at four time points: 1-month pre- (March 2015), 1-month post- (May 2015), 1-year post- (May 2016), and 2-years post-policy implementation (May 2017). Prices for all food items were standardized and converted to price per 100 kcal. Food quality metrics were used to explore potential differential price increases by (a) food groups, as defined by US Department of Agriculture; (b) NOVA food processing categories, and (c) nutrient density quartiles, based on the Nutrient Rich Foods Index 9.3. Separate difference-in-differences linear regression models with robust standard errors, examined price differences per 100 kcal overall, clustered by store chain, and stratified by each food quality metric. Results: There were no overall market basket price changes attributable to Seattle's minimum wage policy. Moreover, no minimum wage effect was detected by USDA food group, food processing, or nutrient density categories. Conclusions: Local area supermarket food prices were not impacted by Seattle's minimum wage policy 2 years into policy implementation and after the first increase to $15/h overall or by sub-classification. Low-income workers may be able to afford higher quality diets if wages increase yet supermarket prices stay the same.


Assuntos
Comércio/economia , Custos e Análise de Custo/economia , Qualidade dos Alimentos , Abastecimento de Alimentos/economia , Pobreza/economia , Salários e Benefícios/economia , Adulto , Cidades/estatística & dados numéricos , Comércio/estatística & dados numéricos , Custos e Análise de Custo/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pobreza/estatística & dados numéricos , Salários e Benefícios/estatística & dados numéricos , Washington
18.
Prev Med ; 118: 122-134, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30316876

RESUMO

We evaluate evidence for the effectiveness of raising minimum wages on various measures of public health within the US, Canada, the UK, and Europe. We search four scientific websites from the inception of the research through May 20, 2018. We find great variety (20+) in measured outcomes among the 33 studies that pass our initial screening. We establish quality standards in a second screening resulting in 15 studies in which we create outcome-based groups. Outcomes include four broad measures (general overall health, behavior, mental health, and birth weight) and eight narrow measures (self-reported health, "bad" health days, unmet medical need, smoking, problem-drinking, obesity, eating vegetables, and exercise). We establish criteria for "stronger" findings for outcomes and methods. Stronger findings include: $1 increases in minimum wages are associated with 1.4 percentage point (4% evaluated at mean) decreases in smoking prevalence; failure to reject null hypotheses that minimum wages have no effects for most outcomes; and no consistent evidence that minimum wages harm health. One "suggestive" finding is that the best-designed studies have well-defined treatment (or likely affected) and control (unaffected) groups and contain longitudinal data. The major methodological weaknesses afflicting many studies are the lack of focus on persons likely affected by minimum wages and omission of "falsification tests" on persons likely unaffected. An additional weakness is lack of attention to how findings might differ across populations such as teenagers, adults, men, women, continuously employed and unemployed persons. Research into health effects of minimum wages is in its infancy and growing rapidly. We present a list of "better practices" for future research.


Assuntos
Emprego/estatística & dados numéricos , Nível de Saúde , Saúde Pública , Salários e Benefícios/legislação & jurisprudência , Canadá , Europa (Continente) , Exercício , Humanos , Saúde Mental , Obesidade , Salários e Benefícios/economia , Desemprego
19.
Balkan Med J ; 36(3): 162-168, 2019 05 10.
Artigo em Inglês | MEDLINE | ID: mdl-30539622

RESUMO

Background: In recent decades, the role of women in the organizations of developed and less developed countries has increased, but little is known about gender gap in salaries of Iranian physicians. Aims: To analyze the gender gap in the salary of physicians working in public health sector of Iran and its predicting factors in 2016. Study Design: Cross sectional study. Methods: Thirty thousand eight hundred and twenty four records about characteristics of study population were extracted from national human resources for health database. Nearest neighborhood matching technique was used to find adjusted differences of salary between male and female physicians. In addition, by using Oaxaca decomposition method, the reasons for the differences were found. Results: The results showed that there was a difference of 117 dollars in monthly salaries of male and female physicians in favor of men. Differences in male and female salaries could be predicted by place of work and residency, type of specialty, type of employment and marital status. Conclusion: Gender gap in physicians' salaries exists in public health sector of Iran. The payment methods of salaries for men and women should be revised in order to remove the inequalities.


Assuntos
Renda/estatística & dados numéricos , Médicos/economia , Salários e Benefícios/economia , Sexismo/economia , Adulto , Estudos Transversais , Feminino , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Médicos/estatística & dados numéricos , Salários e Benefícios/estatística & dados numéricos , Sexismo/estatística & dados numéricos , Fatores Socioeconômicos
20.
J Med Econ ; 22(6): 501-508, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30384792

RESUMO

Background: Human-capital based lifetime productivity estimates are frequently used in cost-of-illness (COI) analyses and, less commonly, in cost-effectiveness analyses (CEAs). Previous US estimates assumed that labor productivity and real earnings both grow by 1% per year. Objectives: This study presents estimates of annual and lifetime productivity for 2016 using data from the American Community Survey, the American Time Use Survey, and the Current Population Survey, and with varying assumptions about real earnings growth. Methods: The sum of market productivity (gross annual personal labor earnings adjusted for employer-paid benefits) and the imputed value of non-market time spent in household, caring, and volunteer services was estimated. The present value of lifetime productivity at various ages was calculated for synthetic cohorts using annual productivity estimates, life tables, discount rates, and assumptions about future earnings growth rates. Results: Mean annual productivity was $57,324 for US adults in 2016, including $36,935 in market and $20,389 in non-market productivity. Lifetime productivity at birth, using a 3% discount rate, is roughly $1.5 million if earnings grow by 1% per year and $1.2 million if future earnings growth averages 0.5% per year. Conclusions: Inclusion of avoidable productivity losses in societal-perspective CEAs of health interventions is recommended in new US cost-effectiveness guidelines. However, estimates vary depending on whether analysts choose to estimate total productivity or just market productivity, and on assumptions made about growth in future productivity and earnings.


Assuntos
Efeitos Psicossociais da Doença , Eficiência , Modelos Econômicos , Salários e Benefícios/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Censos , Feminino , Humanos , Tábuas de Vida , Masculino , Pessoa de Meia-Idade , Salários e Benefícios/economia , Estados Unidos , Adulto Jovem
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