Unemployment and employment dynamics in the Mexican segmented labour market

This paper analyses unemployment and employment dynamics in the urban Mexican labour market. We use amethod to distinguish between the effects of duration dependence and unobserved heterogeneity. Cohort effects are added and identified within the dependent concurrent risks model. We consider the exit from unemployment to the formal and informal sector; the transitions between sectors; and the transitions from the two types of employment to unemployment. The model is estimated on quarterly urban Mexican aggregated data over the period 1987-2001 stratified by sex, age, and education level. It turns out that for all groups of unemployed there is nonmonotonous duration dependence. Unobserved heterogeneity is not found in all groups of unemployed individuals. The first results, obtained from the analysis of the unemployment dynamics do not enable us to conclude that both formal and informal sectors play a specific role, but neither do they show a dynamic or specific behaviour; with similar cohort effects and different duration dependences, the sectors appear symmetrical. The transitions between sectors show shapes of dependence, where we find a primacy of the formal sector over the informal one for some categories of workers, especially males and the more educated. An asymmetrical mechanism within the formal sector thus seems to take place with the employment length in this sector, keeping those workers within the same type of employment. Between the two following quarters, the probabilities of returning to unemployment differ greatly according to the categories of workers and the origin sectors. It is difficult to draw conclusions from those mechanisms of nonmonotonous dependence in the analysis of transitions from employment to unemployment. The transition risks from formal employment, that is to saymobility between sectors or a return to unemployment are overall homogeneous within the different categories of workers. The exit rates from informal employment are very different. Regarding the mobility between sectors from informal to formal, the presence of heterogeneity is systematically significant (except for the less educated workers). Rather than pure cyclical effects, it seems nevertheless that cohort effects make account of the labour market mutations and of the transformations and particularly of the role of employment sectors

Performance of serum biomarkers for the early detection of invasive aspergillosis in febrile, neutropenic patients: a multi-state model

International audienceBACKGROUND: The performance of serum biomarkers for the early detection of invasive aspergillosis expectedly depends on the timing of test results relative to the empirical administration of antifungal therapy during neutropenia, although a dynamic evaluation framework is lacking.METHODS: We developed a multi-state model describing simultaneously the likelihood of empirical antifungal therapy and the risk of invasive aspergillosis during neutropenia. We evaluated whether the first positive test result with a biomarker is an independent predictor of invasive aspergillosis when both diagnostic information used to treat and risk factors of developing invasive aspergillosis are taken into account over time. We applied the multi-state model to a homogeneous cohort of 185 high-risk patients with acute myeloid leukemia. Patients were prospectively screened for galactomannan antigenemia twice a week for immediate treatment decision; 2,214 serum samples were collected on the same days and blindly assessed for (1->3)- β-D-glucan antigenemia and a quantitative PCR assay targeting a mitochondrial locus.RESULTS: The usual evaluation framework of biomarker performance was unable to distinguish clinical benefits of β-glucan or PCR assays. The multi-state model evidenced that the risk of invasive aspergillosis is a complex time function of neutropenia duration and risk management. The quantitative PCR assay accelerated the early detection of invasive aspergillosis (P = .010), independently of other diagnostic information used to treat, while β-glucan assay did not (P = .53). CONCLUSIONS: The performance of serum biomarkers for the early detection of invasive aspergillosis is better apprehended by the evaluation of time-varying predictors in a multi-state model. Our results provide strong rationale for prospective studies testing a preemptive antifungal therapy, guided by clinical, radiological, and bi-weekly blood screening with galactomannan antigenemia and a standardized quantitative PCR assay

Modeling HIV/AIDS Drug Price Determinants in Brazil: Is Generic Competition a Myth?

Brazil became the first developing country to guarantee free and universal access to HIV/AIDS treatment, with antiretroviral drugs (ARVs) being delivered to nearly 190,000 patients. The analysis of ARV price evolution and market dynamics in Brazil can help anticipate issues soon to afflict other developing countries, as the 2010 revision of the World Health Organization guidelines shifts demand towards more expensive treatments, and, at the same time, current evolution of international legislation and trade agreements on intellectual property rights may reduce availability of generic drugs for HIV care.Our analyses are based on effective prices paid for ARV procurement in Brazil between 1996 and 2009. Data panel structure was exploited to gather ex-ante and ex-post information and address various sources of statistical bias. In-difference estimation offered in-depth information on ARV market characteristics which significantly influence prices. Although overall ARV prices follow a declining trend, changing characteristics in the generic segment help explain recent increase in generic ARV prices. Our results show that generic suppliers are more likely to respond to factors influencing demand size and market competition, while originator suppliers tend to set prices strategically to offset compulsory licensing threats and generic competition.In order to guarantee the long term sustainability of access to antiretroviral treatment, our findings highlight the importance of preserving and stimulating generic market dynamics to sustain developing countries' bargaining power in price negotiations undertaken with originator companies

BMJ Open

In low-income settings with limited access to diagnosis, COVID-19 information is scarce. In September 2020, after the first COVID-19 wave, Mali reported 3086 confirmed cases and 130 deaths. Most reports originated from Bamako, with 1532 cases and 81 deaths (2.42 million inhabitants). This observed prevalence of 0.06% appeared very low. Our objective was to estimate SARS-CoV-2 infection among inhabitants of Bamako, after the first epidemic wave. We assessed demographic, social and living conditions, health behaviours and knowledges associated with SARS-CoV-2 seropositivity. We conducted a cross-sectional multistage household survey during September 2020, in three neighbourhoods of the commune VI (Bamako), where 30% of the cases were reported. We recruited 1526 inhabitants in 3 areas, that is, 306 households, and 1327 serological results (≥1 years), 220 household questionnaires and collected answers for 962 participants (≥12 years). We measured serological status, detecting SARS-CoV-2 spike protein antibodies in blood sampled. We documented housing conditions and individual health behaviours through questionnaires among participants. We estimated the number of SARS-CoV-2 infections and deaths in the population of Bamako using the age and sex distributions. The prevalence of SARS-CoV-2 seropositivity was 16.4% (95% CI 15.1% to 19.1%) after adjusting on the population structure. This suggested that ~400 000 cases and ~2000 deaths could have occurred of which only 0.4% of cases and 5% of deaths were officially reported. Questionnaires analyses suggested strong agreement with washing hands but lower acceptability of movement restrictions (lockdown/curfew), and mask wearing. The first wave of SARS-CoV-2 spread broadly in Bamako. Expected fatalities remained limited largely due to the population age structure and the low prevalence of comorbidities. Improving diagnostic capacities to encourage testing and preventive behaviours, and avoiding the spread of false information remain key pillars, regardless of the developed or developing setting. This study was registered in the registry of the ethics committee of the Faculty of Medicine and Odonto-Stomatology and the Faculty of Pharmacy, Bamako, Mali, under the number: 2020/162/CA/FMOS/FAPH

The Creation and Evolution of the Donor Funded Market for Antimalarials and the Growing Role of Southern Firms

International audienceSince the early 2000s, the question of access to medicines at affordable prices for Southern populations has appeared as one of the major challenges for the international governance of health. But what is at stake is the creation of market for medicines in the global South, particularly countries in the Sub-Saharan Africa. These markets are new in nature in the sense that they are driven by international organisations where Southern firms, especially from India, occupy an increasingly important position. However, the specificity of these markets and the way they are constituted have been little analysed. In this article, we suggest focusing the attention on the constitution of the market of antimalarial drugs and highlighting the role played by Southern firms in this market. Our study focuses on the public sector market of antimalarial drugs. We provide an institutional and quantitative analysis of the creation of this public market. We then discuss the growing importance of the Southern firms, mainly Indian and Chinese, in this market

Unemployment and employment dynamics in the Mexican segmented labour market

This paper analyses unemployment and employment dynamics in the urban Mexican labour market. We use amethod to distinguish between the effects of duration dependence and unobserved heterogeneity. Cohort effects are added and identified within the dependent concurrent risks model. We consider the exit from unemployment to the formal and informal sector; the transitions between sectors; and the transitions from the two types of employment to unemployment. The model is estimated on quarterly urban Mexican aggregated data over the period 1987-2001 stratified by sex, age, and education level. It turns out that for all groups of unemployed there is nonmonotonous duration dependence. Unobserved heterogeneity is not found in all groups of unemployed individuals. The first results, obtained from the analysis of the unemployment dynamics do not enable us to conclude that both formal and informal sectors play a specific role, but neither do they show a dynamic or specific behaviour; with similar cohort effects and different duration dependences, the sectors appear symmetrical. The transitions between sectors show shapes of dependence, where we find a primacy of the formal sector over the informal one for some categories of workers, especially males and the more educated. An asymmetrical mechanism within the formal sector thus seems to take place with the employment length in this sector, keeping those workers within the same type of employment. Between the two following quarters, the probabilities of returning to unemployment differ greatly according to the categories of workers and the origin sectors. It is difficult to draw conclusions from those mechanisms of nonmonotonous dependence in the analysis of transitions from employment to unemployment. The transition risks from formal employment, that is to saymobility between sectors or a return to unemployment are overall homogeneous within the different categories of workers. The exit rates from informal employment are very different. Regarding the mobility between sectors from informal to formal, the presence of heterogeneity is systematically significant (except for the less educated workers). Rather than pure cyclical effects, it seems nevertheless that cohort effects make account of the labour market mutations and of the transformations and particularly of the role of employment sectors.Unemployment, Employment, Unemployment duration, Employment duration, Unobserved heterogeneity, Cohort effects, Segmentation

The expected and unexpected benefits of dispensing the exact number of pills.

From November 2014 to November 2015, an experiment in French community pharmacies replaced traditional pre-packed boxes by per-unit dispensing of pills in the exact numbers prescribed, for 14 antibiotics.A cluster randomised control trial was carried out in 100 pharmacies. 75 pharmacies counted out the medication by units (experimental group), the other 25 providing the treatment in the existing pharmaceutical company boxes (control group). Data on patients under the two arms were compared to assess the environmental, economic and health effects of this change in drug dispensing. In particular, adherence was measured indirectly by comparing the number of pills left at the end of the prescribed treatment.Out of the 1185 patients included during 3 sessions of 4 consecutive weeks each, 907 patients experimented the personalized delivery and 278 were assigned to the control group, consistent with a 1/3 randomization-rate at the pharmacy level. 80% of eligible patients approved of the per-unit dispensing of their treatment. The initial packaging of the drugs did not match with the prescription in 60% of cases and per-unit dispensing reduced by 10% the number of pills supplied. 13.1% of patients declared that they threw away pills residuals instead of recycling-no differences between groups. Finally, per-unit dispensing appeared to improve adherence to antibiotic treatment (marginal effect 0.21, IC 95, 0.14-0.28).Supplying antibiotics per unit is not only beneficial in terms of a reduced number of pills to reimburse or for the environment (less pills wasted and non-recycled), but also has a positive and unexpected impact on adherence to treatment, and thus on both individual and public health