Menopause Transition and Labor Market Outcomes

Over the past 50 years, women have become important participants in the labor market. With the increase in the number of middle-aged women going through the menopause transition, the question arises as to the effect of this transition on the labor market. Previous studies have shown that reproductive cycles have a non-trivial negative effect on women’s labor market outcomes. Thus, the cessation of these reproductive cycles (menopause) should bring relief for these women. However, another body of literature asserts that the menopause transition itself has a negative effect on women’s mental and physical health and so may have a negative effect on labor market outcomes. This study seeks to explore the effect of the menopause transition on labor market outcomes. The empirical analyses are done using data from the National Longitudinal Survey of Young Women, with the key explanatory variables being the menopause transition stages: premenopause, perimenopause, surgical menopause and natural postmenopause. The regressions include a control for whether the woman experienced early menopause and whether she had a hysterectomy. The first part of the study examines the impact of the menopause transition on health using depression and the scores on the activities of daily living as the measures of health status. These analyses use cross sectional data drawn from the 1995 wave of the survey for activity limitations and the 2003 wave for the depression measure. The findings of these analyses indicate that the menopause transition increases the likelihood of depression and functional limitations. The main part of the study explores the effect of the menopause transition on the following labor market outcomes: labor force participation, hours worked, full time employment, wages, and self-employment. Ordinary Least Squares, the fixed effects model, the random effects model, and the family fixed effects (siblings) model are used to examine these questions. The analysis also uses 2SLS to correct for endogeneity of the menopause variables and the Heckman two-step procedure to correct for sample selection bias. The findings show that women in premenopause are less likely to be in the labor force than women in natural postmenopause, even after controlling for life-cycle variables. The results also indicate that there are certain benefits from using hormone replacement therapy (HRT), as women who had surgical menopause and are using hormones are more likely to be in the labor force than women with surgical menopause who are not using HRT. Women in premenopause and women in perimenopause are less likely to work full-time compared to women who experienced natural postmenopause. The findings also show that there are no significant differences in hours worked by women in the different menopause stages. Women in premenopause typically earn more than women in natural postmenopause. Furthermore, women in perimenopause and women with surgical menopause are more likely to be self employed. The findings indicate that, among a generally healthy population, the menopause transition results in an increase in labor supply. However, a wage penalty is observed among women in postmenopause, when compared to women who are premenopause. The implications of the findings are that menopause should not be medicalized but should be viewed in a social and cultural context as the changes that occur during the transition may open up possibilities for positive individual development. Thus the cessation of menstrual cycles brings relief for women and results in an increase in labor supply, albeit one associated with a wage penalty

The significance of tasks in second language learning: The case of Africa University in Zimbabwe

Purpose: This study utilised the case study approach for an in-depth understanding of the practices of teaching English as a Second Language (ESL) at Africa University (AU), Zimbabwe. The study aimed to provide a description of unique and typical ESL experiences in a particular African context. Research Methodology: The study investigated 60 participants who were prospective undergraduate students enrolled in the ESL programme and were separated into two groups. Each group consisted of 30 participants who received task-based instruction hinged on reading, writing, listening, and speaking. Result: An analysis of the learners' performance revealed that tasks facilitate the learning of ESL by exposing learners to different problem-solving scenarios that required higher-order cognitive skills. Limitations: This study was based on the ESL classroom at AU, which enrols students from African countries. A similar study could be conducted with students from more diverse backgrounds to establish if the results of this study could be corroborated or refuted. Similar studies could also be conducted in other second language contexts where English is not the target language. Contribution: The results of this study are important for the discipline of ESL as they support existing knowledge that tasks allow learners to communicate using the correct grammatical structures in a given relevant context

Memory and violence: Displaced Zimbabwean rural communities reliving the memories of the March 2008 political violence.

This thesis is premised on the argument that a distinct kind of narrative (‘truth’) about political violence, a narrative of the first-person experience, a narrative that is valued for its power to counter totalising historical narratives, is thought to reside in the subjective experience of each individual. Be that as it may, this study aimed to answer the question: What meanings do rural Zimbabweans who were internally displaced by the March 2008 state-sponsored political violence attach to this violence? In particular, the study investigated these meanings in a context where the victims remain(ed) in close proximity to the perpetrators during and after the violence. It also examined these meanings in an alleged silence by the state and local communities, and how these meanings have shaped the victims’ present socio-political identities. In order to answer the question, in-depth narrative interviews were conducted with purposively selected respondents. The study assumed a qualitative exploratory design which was underpinned by the phenomenological and constructionist theoretical approaches. It was concluded that the victims’ interpretation of the state-sponsored political violence is negotiated and mediated in the course of interaction. The personal narrative of the memory attains some latent political and redemptive value when it is interpreted in a social context. The meanings of the violence particularly assume a complex moral and ethical plane in a scenario where the perpetrator remains a permanent feature in the victim’s physical and social space, without any recourse. The complexity is imminent as the victim has to contend with the socio-psychological effects of the daily direct interface with their unpunished aggressor especially due to the communal nature of rural life. It was also concluded that the 2008 state-sponsored violence was increasingly interpreted as unfinished business by the victims. More so, it was also understood to be synonymous and complicit with silence at the communal and national level. Thus, the silence was synonymous with adaptation to power relations, cultural censorship, and liminality. In terms of identity, the victims suffer an identity crisis. They have developed personalities that have arguably, failed to internalise a sense of self as trusting and trustworthy. Last, the identification of the violence as unfinished business has also led to the reaffirmation of the victims’ spiritual identities as they have invoked bewitchment to avenge the death of their loved ones and in the process try to reconnect with them spiritually by invoking their spirits to seek revenge

South African shipping and ship finance : constraints and prospects of container shipping joint venture

Study project (M. Phil.) -- University of Stellenbosch, 1999.ENGLISH SUMMARY: The changes taking place in the maritime trade provide broad and complex areas of interrelationships that can be identified as the main reason leading to the need for a joint venture South African container industry. The world economics and commercial developments, intense competition, low freight rates, high operational cost, liquidations, loss of market share and trade necessitated the investigation of market strategies that will provide the South African container industry with a sustainable comparative advantages on the traditional North/South route. This study addresses the benefits of a joint venture between Safmarine and a South African Black Operator. The benefit of the joint venture is dual. Firstly, the operational benefits are realising economies of scale, more access to capital finance, stronger bargaining power and acquisition of a bigger market share. Secondly, there are benefits to the South African Balance of Payments because of retained foreign exchange spending on freight rates, the gaining of foreign exchange on freight earnings, the benefits associated with the flying of the South African flag, the skills transfer and maintenance of management skills in South Africa, and the opportunity to create black economic empowerment. With the expected growth and recovery of an export-led economy the latent benefits of a South African operator could have been realised if such a joint venture could have come about. However, Safmarine Container Line was sold to a foreign shipowner, i.e. AP Moller. Although, most of the operational benefits can be realised with such a buy-out, South Africa has lost the opportunity to become a significant player in the· shipping trade with ancillary benefits.AFRIKAANSE OPSOMMING: Die veranderinge wat tans plaasvind in die maritieme handel veroorsaak wye en komplekse areas van onderlingsooreenkomste wat geidentifiseer kan word as die hoofrede vir die behoefte om 'n gesanientlike ooreenkoms in die Suid Afrikaanse houerskip industrie. Die wereld ekonomiese en kommersiele ontwikkelinge, hewige kompetisie, lae vragtariewe, hoe bed ryfskoste , likwidasies, verlies aan markaandeel en handel noodsaak die ondersoek na nuwe vergelykbare mark strategiee wat die Suid Afrikaanse houerskip industrie sal verseker van 'n langdurige kompeterende voordeel in die tradisionele Noord/Suid markte sal verseker. Hierdie studie spreek die voordele van 'n gesametlike ooreenkoms tusseo Safmarine, en 'n Suid Afrikaanse Swart Operateur aan, Die voordeel is tweeledig. Eerstens, die bedryfsvoordele deurdat skaalvoordele gerealiseer word, meer toegang tot kapitale finansiering verkry kan word, sterker mededingende mag en die verkryging van 'n groter markaandeel. Tweedens, is daar voordele vir die Suid Afrikaanse Betalingsbalans deurdie voorkoming van uitvloei van buitelandse val uta aan vraggeld en versekering, die inkomste uit vragverdienste, die verdien van buitelandse valuta aan vraggeld, die voordele wat gepaardgaan met die vaar van die Suid Afrikaanse vlag, die oordrag van vaardigheid en die behoud van bestuursvermoe in Suid Afrika, en die geleentheid am swart ekonomiese vol mag te skep. Met die verwagte ekonomiess groei en herstel van 'n uitvoer-gebasseerde ekonomie kon die latente voordeel van 'n Suid Afrikaanse operateur verwesentlik word indien so 'n gesamentlike ooreenkoms plaas gevind het Nieteenstaande, Safmarine Container Line was verkoop aan 'n buitelandse skeepseienaar, i.e. AP. Moller. Alhoewel, meeste van die bedryfsvoordele verwesentlik word as gevolg van die transaksie, het Suid Afrika die geleentbeid verloor om 'n merkwaardige mededinger in die seehandel te word met die aanverwante voordele wat dit bied

HIV prevention is not all about HIV - using a discrete choice experiment among women to model how the uptake and effectiveness of HIV prevention products may also rely on pregnancy and STI protection.

INTRODUCTION: In sub-Saharan Africa, considerable HIV-burden exists among women. Anti-retroviral (ARV) based prevention products could decrease this burden, and their uptake could be increased if they also protect against pregnancy and sexually transmitted infections (STI). METHODS: A discrete choice experiment (DCE) was undertaken in South Africa (2015) through a household survey of adult females (n = 158) and adolescent girls (n = 204) who self-reported HIV-negative status. The DCE was used to project the uptake (percentage using product) of oral pre-exposure prophylaxis (PrEP), vaginal rings, and injectable long-lasting ARV agents among these women, and how uptake could depend on whether these products protect against pregnancy or STI acquisition. Uptake estimates were used to model how each product could decrease a women's HIV acquisition risk. RESULTS: In adolescent women, there will be limited uptake ( 14% of women will remain unprotected and > 31% of the baseline acquisition risk will remain. CONCLUSIONS: Incorporating multiple prevention components into new ARV-based prevention products may increase their uptake and impact among women

A Cost-Effectiveness Analysis of a Program to Control Rheumatic Fever and Rheumatic Heart Disease in Pinar del Rio, Cuba

BACKGROUND: Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) persist in many low- and middle-income countries. To date, the cost-effectiveness of population-based, combined primary and secondary prevention strategies has not been assessed. In the Pinar del Rio province of Cuba, a comprehensive ARF/RHD control program was undertaken over 1986 - 1996. The present study analyzes the cost-effectiveness of this Cuban program. Methods and FINDINGS: We developed a decision tree model based on the natural history of ARF/RHD, comparing the costs and effectiveness of the 10-year Cuban program to a “do nothing” approach. Our population of interest was the cohort of children aged 5 - 24 years resident in Pinar del Rio in 1986. We assessed costs and health outcomes over a lifetime horizon, and we took the healthcare system perspective on costs but did not apply a discount rate. We used epidemiologic, clinical, and direct medical cost inputs that were previously collected for publications on the Cuban program. We estimated health gains as disability-adjusted life years (DALYs) averted using standard approaches developed for the Global Burden of Disease studies. Cost-effectiveness acceptability thresholds were defined by one and three times per capita gross domestic product per DALY averted. We also conducted an uncertainty analysis using Monte Carlo simulations and several scenario analyses exploring the impact of alternative assumptions about the program’s effects and costs. We found that, compared to doing nothing, the Cuban program averted 5051 DALYs (1844 per 100,000 school-aged children) and saved $7,848,590 (2010 USD) despite a total program cost of$202,890 over 10 years. In the scenario analyses, the program remained cost saving when a lower level of effectiveness and a reduction in averted years of life lost were assumed. In a worst-case scenario including 20-fold higher costs, the program still had a 100% of being cost-effective and an 85% chance of being cost saving. CONCLUSIONS: A 10-year program to control ARF/RHD in Pinar del Rio, Cuba dramatically reduced morbidity and premature mortality in children and young adults and was cost saving. The results of our analysis were robust to higher program costs and more conservative assumptions about the program’s effectiveness. It is possible that the program’s effectiveness resulted from synergies between primary and secondary prevention strategies. The findings of this study have implications for non-communicable disease policymaking in other resource-limited settings

The cost-effectiveness of multi-purpose HIV and pregnancy prevention technologies in South Africa.

INTRODUCTION: A number of antiretroviral HIV prevention products are efficacious in preventing HIV infection. However, the sexual and reproductive health needs of many women extend beyond HIV prevention, and research is ongoing to develop multi-purpose prevention technologies (MPTs) that offer dual HIV and pregnancy protection. We do not yet know if these products will be an efficient use of constrained health resources. In this paper, we estimate the cost-effectiveness of combinations of candidate multi-purpose prevention technologies (MPTs), in South Africa among general population women and female sex workers (FSWs). METHODS: We combined a cost model with a static model of product impact based on incidence data in South Africa to estimate the cost-effectiveness of five candidate co-formulated or co-provided MPTs: oral PrEP, intravaginal ring, injectable ARV, microbicide gel and SILCS diaphragm used in concert with gel. We accounted for the preferences of end-users by predicting uptake using a discrete choice experiment (DCE). Product availability and protection were systematically varied in five potential rollout scenarios. The impact model estimated the number of infections averted through decreased incidence due to product use over one year. The comparator for each scenario was current levels of male condom use, while a health system perspective was used to estimate discounted lifetime treatment costs averted per HIV infection. Product benefit was estimated in disability-adjusted life years (DALYs) averted. Benefits from contraception were incorporated through adjusting the uptake of these products based on the DCE and through estimating the costs averted from avoiding unwanted pregnancies. We explore the additional impact of STI protection through increased uptake in a sensitivity analysis. RESULTS: At central incidence rates, all single- and multi-purpose scenarios modelled were cost-effective among FSWs and women aged 16-24, at a governmental willingness-to-pay threshold of $1175/DALY averted (range:$214-$810/DALY averted among non-dominant scenarios), however, none were cost-effective among women aged 25-49 (minimum$1706/DALY averted). The cost-effectiveness of products improved with additional protection from pregnancy. Estimates were sensitive to variation in incidence assumptions, but robust to other parameters. CONCLUSIONS: To the best of our knowledge, this is the first study to estimate the cost-effectiveness of a range of potential MPTs; suggesting that MPTs will be cost-effective among higher incidence FSWs or young women, but not among lower incidence older women. More work is needed to make attractive MPTs available to potential users who could use them effectively

Introduction of rotavirus vaccination in Palestine: An evaluation of the costs, impact, and cost-effectiveness of ROTARIX and ROTAVAC.

INTRODUCTION: The Palestinian Ministry of Health (MOH) started a routine rotavirus immunization program with ROTARIX in May 2016, with support for vaccine procurement and introduction provided through a global development organization. In 2018, financial responsibility for rotavirus vaccine procurement was transferred to the Palestinian government, which elected to shift to ROTAVAC vaccine because of its lower price per dose. This study aims to assess the cost, impact, and cost-effectiveness of rotavirus vaccination, specifically evaluating the economic implications of the change in vaccine product, accounting for the different characteristics of each rotavirus vaccine used. METHODS: We conducted primary and secondary data collection to assess the introduction, procurement, supply chain, and service delivery costs related to each vaccine. We used the UNIVAC model to project costs and benefits of rotavirus vaccination over a 10-year period comparing the use of ROTARIX versus no vaccination; ROTAVAC versus no vaccination; and ROTAVAC versus ROTARIX. We undertook scenario and probabilistic analyses to capture uncertainty in some of the study parameters. We used a 3% discount rate, and all costs are in 2018 US$. RESULTS: The cost to deliver one dose was lower for ROTAVAC than ROTARIX (US$2.36 versus $2.70), but the total cost per course, excluding vaccine cost, favored ROTARIX ($7.09 versus $5.39). Both vaccines had high probability of being cost-effective interventions in Palestine compared to no vaccine. Because of lower vaccination program costs for ROTAVAC, however, switching from ROTARIX to ROTAVAC was cost-saving. CONCLUSION: National decision-makers should consider systematically assessing multiple criteria beyond vaccine price when comparing the health and economic value of several products in order to fully account for all characteristics including product presentation, number of doses per course, cold chain volume, cost of delivery, and wastage

To expand coverage, or increase frequency: Quantifying the tradeoffs between equity and efficiency facing cervical cancer screening programs in low‐resource settings

Cervical cancer is a leading cause of cancer death worldwide, with 85% of the disease burden residing in less developed regions. To inform evidence‐based decision‐making as cervical cancer screening programs are planned, implemented, and scaled in low‐ and middle‐income countries, we used cost and test performance data from the START‐UP demonstration project in Uganda and a microsimulation model of HPV infection and cervical carcinogenesis to quantify the health benefits, distributional equity, cost‐effectiveness, and financial impact of either (1) improving access to cervical cancer screening or (2) increasing the number of lifetime screening opportunities for women who already have access. We found that when baseline screening coverage was low (i.e., 30%), expanding coverage of screening once in a lifetime to 50% can yield comparable reductions in cancer risk to screening two or three times in a lifetime at 30% coverage, lead to greater reductions in health disparities, and cost 150 international dollars (I$) per year of life saved (YLS). At higher baseline screening coverage levels (i.e., 70$590 per YLS) below Uganda's per capita GDP. Given very low baseline coverage at present, we conclude that a policy focus on increasing access for previously unscreened women appears to be more compatible with improving both equity and efficiency than a focus on increasing frequency for a small subset of women

Discontinuation of thyroid hormone treatment among children in the United States with congenital hypothyroidism: findings from health insurance claims data

<p>Abstract</p> <p>Background</p> <p>Thyroid hormone treatment in children with congenital hypothyroidism can prevent intellectual disability. Guidelines recommend that children diagnosed with congenital hypothyroidism through newborn screening remain on treatment to at least 3 years of age, after which a trial off therapy can determine which children have transient hypothyroidism. The purpose of this study was to describe the rate at which children with congenital hypothyroidism in the United States discontinue thyroid hormone treatment in early childhood.</p> <p>Methods</p> <p>Retrospective analysis of the 2002-2006 MarketScan^®Commercial Claims and Encounters research databases and the 2001-2005 MarketScan Multi-State Medicaid databases. Children were classified as having congenital hypothyroidism based on billing codes and having filled a prescription for thyroid hormone treatment. Kaplan-Meier curve analysis was used to determine discontinuation rates.</p> <p>Results</p> <p>There were a total of 412 Medicaid-enrolled children and 292 privately-insured children with presumed congenital hypothyroidism included in this study. The overall birth prevalence of congenital hypothyroidism across both datasets was about 1 per 2,300. By 36 months, the percentage who had discontinued thyroid replacement treatment was 38% (95% Confidence Interval: 32%-44%). Medicaid-enrolled children had a more rapid decline in the first 24 months of treatment compared to those with private insurance (<it>P </it>= 0.02).</p> <p>Conclusions</p> <p>More than one-third of children treated for congenital hypothyroidism discontinued treatment within 36 months, which is inconsistent with current guidelines. It is not known how many of these children required continued treatment or experience adverse effects from discontinuation. These findings emphasize the critical need for follow-up systems to monitor the outcome of newborn screening.</p