Zeitschriftenartikel zum Thema „Medical personnel Salaries“

The paper shows the principles of organizing the transition of Russian citizens to medical savings accounts (MSA). A simulation of the accumulation of financial resources on the MSA of all categories of citizens of the Russian Federation was performed, taking into account the need for a significant increase in the salary of medical personnel, namely: in accordance with the “may” Decrees of 2012, V. V. Putin, to bring the salary of doctors to a level twice higher than the average for the region by 2018. It is proved that for all categories of Russian citizens, including citizens, have chronic diseases, the funds accumulated on their personal MSA, will be sufficient to cover the costs of medical care given the salaries of medical personnel established in the “may” decrees of the President of the Russian Federation.

The article proves that it is impossible to achieve a significant increase in the salary of medical personnel within the existing system of healthcare financing of the Russian Federation, namely, in accordance with the “may” Decrees of 2012 by V. V. Putin, to bring the salary of doctors to a level twice higher than the average for the region by 2018. It is proved that to achieve the necessary results in terms of increasing doctors’ salaries and motivating citizens to increase labor productivity and a healthy lifestyle, it is necessary to transfer the system of healthcare financing within the framework of obligatory medical insurance to medical savings accounts.

In recent years, a new economic and legal environment has been formed in the activities of budgetary institutions, which makes it possible to raise the level of provision of state social services, to use market mechanisms in the context of legalizing the provision of paid services by a budget institution; labor motivation of employees of public institutions is increased due to the introduction of an effective contract. Using the example of public health institutions, the dynamics of the average wage of doctors to the average monthly wage of hired employees of commercial organizations and individual entrepreneurs by regions are investigated; The analysis of legislative innovations on co-financing the salaries of doctors and nursing staff at the expense of the rationed safety stock of the territorial fund of the OMS was carried out, which should really ensure an increase in the salaries of medical workers and reduce the shortage of primary health care personnel.

Background: Salaries, supplies and machinery account for bulk of public funding necessitating efficient utilisation. Studies suggest that process re-engineering helps improve cost, quality, service, and speed. Disbanded once and re-commissioned, a centralized Inhalational Therapy Unit (ITU) banked and provided portable mechanical ventilators to the inpatient wards. A demand for new ventilators from ITU led to the present study involving its critical review and cost analysis.Methods: An interventional study was conducted at a large tertiary care public hospital in India from April 2015 to June 2015. Critical review of process of providing portable ventilators and cost analysis were conducted. Review of records of and interview with ITU personnel and nursing staff were carried out. Fundamental rethinking and radical redesign of the process was done with attention to human resource, costs, space and actual medical equipment utilization. Two fundamental questions of process re-engineering were deliberated upon: “Why do we do what we do?” “And why do we do it the way we do?” Fundamental rethinking for new process was organized around the outcome.Results: Average utilization coefficient was 6.2% (3.3% to 12.1%). Ventilators utilized per day were 1.43. Expenditure on salaries was INR 315000 per month and INR 10500 per day. Low utilization offered low value for expenses incurred. All activities in ITU focused on “provision of ventilators” (outcome) and the old rule was, “If one needed a ventilator one must contact ITU”. Since nurses were using the “outcome” and performed activities of arranging, they were handed-over the ventilators (based on utilisation patterns). ITU was disbanded, human resource and space were re-allocated to various hospital areas (costs tied were done away with) with no adverse effect on hospital functioning.Conclusions: Process re-engineering led to improved healthcare delivery, curtailed delays in hospital processes, optimised costs involved in human resources and medical equipment.

6143 Background: The University of Kansas Medical Center (KUMC) has offered oncology services via interactive tele-video (ITV) to patients in rural Kansas for over a decade. A KUMC oncologist utilizes ITV technology to connect with patients at Hays Medical Center (HMC), which is approximately 265 west of KUMC. The technology enables the oncologist to conduct a complete patient visit without being in physical proximity to the patient. To date, two cost-tracking studies have been conducted to determine expenses associated with the tele-oncology practice. A third study recently analyzed costs incurred during fiscal year 2005 (FY05). Methods: In order to determine the costs of the practice during FY05, HMC and KUMC expenses were monitored for oncology services rendered via telemedicine. An analysis revealed expenses common to a traditional oncology practice and additional expenses unique to a telemedicine practice. Administrative support staff salaries, the oncologist’s contract fees, and nursing staff salaries made up the majority of the traditional practice-related expenses. Costs unique to a tele-oncology practice were those associated with technology including expenses for telemedicine equipment, telecommunication charges, and technician time. Results: Expenses for the tele-oncology practice on the KUMC side totaled $22,848, with $7,331 attributed to technology-related costs and $15,517 attributed to practice-related costs. For HMC, $5,803 in technology-related costs and $30,430 in practice-related costs totaled $36,233. At 235 tele-oncology consults and a combined total expense of $59,081 between KUMC and HMC, the FY05 analysis resulted in an average cost of $251 per consult. When compared to prior studies, this shows a substantial reduction in costs related to the practice of telemedicine. Conclusions: The average cost of a tele-oncology visit in Kansas has consistently decreased significantly since the practice’s 1995 inception. Analyses have revealed that the costs of providing oncology services via telemedicine are closely tied to utilization, as the majority of the expenses are related to personnel rather than technology. Telemedicine has proven itself to be a cost-efficient alternative to offering regular outreach clinics. No significant financial relationships to disclose.

The purpose of this paper is to examine the efficiencies of United Kingdom life insurance, which is regulated in the NHS with a tax-based funding system. The effectiveness of the Health Insurance System, will provide better health services for the people. Currently, there are still many complaints in the BPJS service system, such as late payments for hospitals and salaries for medical personnel. This study will use the comparative law method, by comparing the BPJS system in Indonesia with the NHS health insurance system in the UK. BPJS uses a monthly fee funding system, the amount of payment are depends on the types of class that BPJS participants has taken. Whereas the NHS only uses a tax-based funding system, where the use of this system can effectively meet all health service needs maximally. Based on the results of research on OECD countries, it is revealed that the tax-based social health insurance program tends to be more progressive and fair. Based on this comparative study, it is important for Indonesia to improve its health insurance system arrangements in order to adapt the tax-based funding system.

Introduction: The State Emergency Medical System (PRM) exists to provide assistance to every person in state of sudden threat to their health or life, operates 24 hours a day, 7 days a week, all year round. The units of the system are hospital emergency departments (SOR) and emergency medical teams, including aviation emergency medical teams. The obvious purpose of the PRM System, which is to save life of human, as any complex activity, is sometimes put to the proof. Appearing and publicised by media cases of late medical attention, calls ignored by a dispatcher or sending emergency medical teams from hospital to hospital seriously undermine the reputation of healthcare service in Poland. The aim: Evaluation of organization of the PRM System in Poland by practitioners – medical staff of Hospital Emergency Departments, ambulance personnel and medical students. Material and methods: The material included a group of 138 interviewees from 768 participants of the 11th Emergency Medicine Conference Kopernik 2018. The research tool was the author’s survey consisting of 12 thematic questions, including one open question, and the part collecting sociodemographic data. The collected empirical material was given descriptive and statistical analysis using Microsoft Excel. The results were presented by calculating the arithmetic mean, median, dominant, standard deviation, coefficient of variation and% of responses respectively. Results: In the majority of respondents’ opinion the organization of the PRM system in Poland is average. The vast majority of respondents (64%) consider the two-people “P” teams to be insufficient. Problems the most often reported by the respondents were lack/or insufficient number of trainings, underfunding of the system, large salaries disparities, shortages of staff, hampered cooperation with other services. Conclusions: The analysis of selected items of the organization of the State Emergency Medical Service in Poland in opinion of practitioners points out the need to implement organizational changes which could improve the system.

This article is devoted to V.V. Trofimov, Minister of Health of the RSFSR, an outstanding health care manager, who tried to introduce the modern methods of self-financing, automated information systems, etc., into the management of medical science during the period 1962-1983. At the initiative of V.V. Trofimov, for the first time in the country, the Main Department of research institutes and coordination of scientific research was established, the purpose of which was to ensure a scientific breakthrough in medicine through the development and implementation of innovative methods. The experience of joint work of health authorities, medical universities, and research institutions began to accumulate. It allowed solving problems of improving the quality of medical care according to united comprehensive plans. The material and technical base for public health protection was developed. During the tenth five-year plan alone, 20 large multi-specialty hospitals were built for 600-1200 beds, 88 polyclinics for 750-1200 visits per shift, 80 maternity hospitals and departments for 8849 beds were put into operation, 24 women’s consultations for 1000 visits per shift, and 13 multi-specialty children’s hospitals. The availability of medical personnel increased from 34.8 in 1975 to 40.0 in 1980 (per 10,000 population). The reform of the financing of medical institutions included the transfer of hospitals and polyclinics to economic accounting. The reform was introduced to enhance medical workers’ financial incentives to improve medical care, as savings increased doctors’ and nurses’ salaries. In essence, it was an anti-pod to the extensive, expensive way of conducting the national economy adopted in the country. As the first Editor-in-Chief of the journal “Health Care of the Russian Federation” and he prioritized innovative research in editorial policy for many years to come.

The analysis of vacancies and job offers for doctors, especially information on the declared amount of wages and benefits, allows not only to study the need for personnel, but also to study the level of motivation of candidates for medical posts. The aim of the study was to analyze vacancies and job offers for doctors from state medical organizations of the Irkutsk region. The study was conducted using the method of continuous statistical analysis of job offers for physicians posted on the official website of the Ministry of Health of the Irkutsk region. The public sector of the healthcare system in the Irkutsk region provides a large number of vacancies for unemployed doctors and young professionals. Declared in job advertisements, the salary level of doctors is below the level reflected in regional state reports on the health of the population and the organization of health care. There is a lag in the salaries of medical workers from the average for the region, as well as the backlog of the Irkutsk region in this indicator from the Russian Federation. When comparing the municipalities of the region to the maximum and minimum declared wage levels, it is revealed that the difference between them is almost fourfold. Although the most demanded are doctors who provide primary health care, the need for these specialists does not correlate with the level of wages offered to them in vacancy announcements. Fourfold excess of the maximum declared wage level over the minimum in the municipal formations of the region is not a consequence of taking into account difficult working conditions in hard-to-reach areas, but is due exclusively to factors of economic nature.

AbstractObjective:To determine (1) the annual costs of implementing and maintaining tuberculin skin test (TST) programs at participating study sites, (2) the cost of the TST program per healthcare worker (HCW), and (3) the outcomes of the TST programs, including the proportion of HCWs with a documented TST conversion and the proportion who accepted and completed treatment for latent TB infection, before and after the implementation of staffTRAK-TB software (Centers for Disease Control and Prevention, Atlanta, GA).Design:Cost analysis in which costs for salaries, training, supplies, radiography, and data analysis were collected for two 12-month periods (before and after the implementation of staffTRAK-TB).Setting:Four hospitals (two university and two city) and two health departments (one small county and one big city).Results:The annual cost of implementing and maintaining a TST program ranged from $66,564 to $332,728 for hospitals and $92,886 to $291,248 for health departments. The cost of the TST program per HCW ranged from $41 to $362 for hospitals and $176 to $264 for health departments.Conclusions:Costs associated with implementing and maintaining a TST program varied widely among the participating study sites, both before and after the implementation of staffTRAK-TB. Compliance with the TB infection control guidelines of the Centers for Disease Control and Prevention may require a substantial investment in personnel time, effort, and commitment.

Objective.To determine the cost of management of occupational exposures to blood and body fluids.Design.A convenience sample of 4 healthcare facilities provided information on the cost of management of occupational exposures that varied in type, severity, and exposure source infection status. Detailed information was collected on time spent reporting, managing, and following up the exposures; salaries (including benefits) for representative staff who sustained and who managed exposures; and costs (not charges) for laboratory testing of exposure sources and exposed healthcare personnel, as well as any postexposure prophylaxis taken by the exposed personnel. Resources used were stratified by the phase of exposure management: exposure reporting, initial management, and follow-up. Data for 31 exposure scenarios were analyzed. Costs were given in 2003 US dollars.Setting.The 4 facilities providing data were a 600-bed public hospital, a 244-bed Veterans Affairs medical center, a 437-bed rural tertiary care hospital, and a 3,500-bed healthcare system.Results.The overall range of costs to manage reported exposures was $71-$4,838. Mean total costs varied greatly by the infection status of the source patient. The overall mean cost for exposures to human immunodeficiency virus (HIV)-infected source patients (n = 19, including those coinfected with hepatitis B or C virus) was $2,456 (range, $907-$4,838), whereas the overall mean cost for exposures to source patients with unknown or negative infection status (n = 8) was $376 (range, $71-$860). Lastly, the overall mean cost of management of reported exposures for source patients infected with hepatitis C virus (n = 4) was $650 (range, $186-$856).Conclusions.Management of occupational exposures to blood and body fluids is costly, the best way to avoid these costs is by prevention of exposures.

The article presents the results of the phased timing of the implantation and the production of a permanent prosthesis on implants with complete absence of teeth. The results of the economic calculation of the cost price of prosthetics on implants are given in view of labor costs, material costs, wages and other expenses. The labor intensity and cost of the implantation and prosthesis manufacturing operation were determined, in the amount of 18.8 hours and 98.5 thousand rubles, respectively. In the structure of labor, prosthetics on implants with complete absence of teeth, the labor of the surgeon, orthopedist, dental technician and the operation of technological equipment without the participation of the operator are approximately uniform. In the structure of the cost of prosthetics on implants up to 70.0% is occupied by material costs (cost of implants and components, alloys and ceramics); The salaries of medical personnel and support staff are 22.0%. The discrepancy between the calculated cost price of prosthetics on implants and the higher prices for such prosthetics existing in clinics is due to the need to purchase new equipment and materials, as well as the need to pay higher wages to qualified dentists and dental technicians in comparison with the minimum salary under the Presidential Decrees of May.

Abstract The purpose of this study was to study the institutional environment of higher medical and medical colleges (HMC and MC), including such components as «The quality of the educational process»; «Administration of the educational process and safety culture»; «The quality of the scientific process»; «The quality of the clinical process»; «Anti-corruption culture and anti-corruption». Methods.The research was carried out on the basis of a survey of students, teachers and administrative and management personnel (AMP). In total, respondents from 73 HMC and MC took part in the survey, including 13 110 students, 825 teachers and 199 representatives of AMP. Results. An analysis of the qualitative characteristics of the persons who were accepted in the survey indicates a lack of nursing education and an insufficient level of academic achievement (confirmed by a scientific / academic degree) in the majority of AMP and teachers of the HMC and MC. At the same time, teachers with little pedagogical experience and AMP with no / short duration of pedagogical experience tend to overestimate all the studied questions. Analysis of the administration of the educational process and safety culture indicates that teachers and AMP give a much higher assessment of ensuring the rights of students and the level of friendliness of relations with students than the students themselves, which, in fact, indicates insufficient contact between teachers and AMP with students in terms of assessing their needs and requirements; The analysis of the quality of the scientific process indicates that the least accessible for the research work of students are the presence of electives in scientific areas, work in the laboratory, the opportunity to travel to scientific conferences in the Republic of Kazakhstan, to near and far abroad. All categories of respondents require building competence in working with scientific knowledge bases Scopus, Web of Science Nursing Reference Center Plus, CINAHL (EBSCO). An analysis of the quality of the clinical process indicates that, on average, only 2/3 of the respondents, students and teachers note satisfaction with the equipment of clinical sites, the provision of the necessary premises and resources from the clinical sites, access to medical equipment at clinical sites, and access to patients. AMP tends to give a higher assessment of the quality of the clinical process. An analysis of the level of anti-corruption culture indicates that the greatest risk of situations in which elements of corruption in college are most common occurs when entering college, when passing midterm exams (ratings), when passing final exams and tests. As the main reasons for corruption in college, the majority of respondents indicate the low level of teacher salaries, low interest in studying among students. The teaching staff and the AMP give a much higher assessment of satisfaction with the level of response of the college administration to complaints regarding the facts of corruption and unethical attitude than the students themselves. Сonclusions. The results of the study indicate the need to strengthen the selection of personnel for the AMP positions in colleges with the introduction of a mandatory requirement for the presence of at least 5 years of teaching experience, the presence of an academic degree. According to the experience of leading foreign universities and colleges, it is necessary to encourage the practice of combining teaching positions and positions of administrative and managerial personnel. It is necessary to introduce mandatory certification of college teachers, as well as mandatory certification of AMP, every 3-5 years according to clear KPI criteria that assess their work. The discrepancy in the assessments of certain categories of respondents indicates the need for regular feedback from students, conducting questionnaires by teaching staff, AMP and other categories of employees in order to study the institutional environment of MC and HMC and prompt response to problems voiced by students and employees. Keywords: medical college, medical education, Kazakhstan.

The Russian Federation is undergoing serious socio-economic changes, including those in the Russian healthcare system. High morbidity and mortality rates increase the population's need for medical care. It also increases the requirements of the society to doctors. Doctors have to solve not only medical, but also complicated legal, psychological, ethical problems. Aim. To analyze satisfaction of medical workers of obstetric and gynecological service in rural areas with working conditions (on an example of the Ryazan region) on the basis of the results of questioning. Materials and Methods. Acquisition of statistical material was carried out by the method of questioning of the obstetric and gynecological service workers (n=18) using the questionnaire developed by the authors. The questionnaire included questions concerning the working conditions, satisfaction with salary, organization of work, and also relationship with administration, colleagues and patients. Statistical data processing was carried out using Statistica 10.0 program. The method of descriptive statistics with determination of the arithmetic mean, variance and calculation of 95% confidence interval was used. Results. It was found that 83.3% of employees of the obstetric and gynecological service of the Ryazan region, including 80.0% of doctors and 84.6% of midwives, were in general satisfied with the work. Here, 61.1% of respondents noted filling in of a large volume of reporting forms and medical documentation. Only 22.2% of the surveyed employees of the obstetric and gynecological service saw the absolute possibility of their professional growth in the medical organization. Relationships with patients were evaluated as full trust and mutual understanding by 72.2% of respondents. Conclusion. The conducted pilot study clearly demonstrated that satisfaction of healthcare workers with working conditions implies many factors concerning the content and conditions of their professional activities. Improvement of the efficiency of the activity and job satisfaction of medical workers can be achieved by a number of measures based on the principles of quality management system: continuous improvement, leadership, staff involvement, relationship management. Increase in satisfaction of healthcare workers with working conditions is the basis for elimination of shortage of personnel in the healthcare sector, for provision of primary healthcare units including those in remote areas of the country and rural areas, with personnel, and assurance of the quality of medical care. The study showed that workers of the obstetric and gynecological service of the Ryazan region are generally satisfied with the working conditions, are provided with tools enabling them to take clinical decisions, highly appreciate the moral and psychological climate in the team. At the same time, a high percentage of respondents noted filling in a large volume of reporting forms and medical documentation, lack of opportunities for professional growth and low salaries.

"The study provides the documentation for the first public version of the database Digital Framework for the History of the Austrian Military Border in Transylvania by means of a detailed description and user manual. It includes: a short overview of the historical context of the establishment of the Austrian military border in this province, references to the international and Romanian state of the art, the detailing of primary sources issued by the military environment and starting from which the database was built and the main principles of construction and operation of the latter. The information in the database is extracted from the records of the military and administrative personnel of the Transylvanian border regiments between 1763 and 1850, including monthly staff records, information on salaries, enrollments, transfers, desertions, medical certificates, etc. The lists of conduct of the officers should also be mentioned, each of them including a detailed physical and psychological description of the respective person. The database serves two aims. On the one hand, to boost the use of and access to documents generated by the Austrian military and with this to bring the Romanian historical writing on the military border in Transylvania closer to the primary sources. On the other hand, to complement, for the territory of the former military border, the vital registration data provided by parish registers with social history data that can improve life course reconstruction and analysis. Keywords: Historical databases, Austrian Military Border, Transylvania, Habsburg Monarchy, Military history "

6637 Background: QOC is a goal of all oncology practices (op), healthcare insurance plans (hip), HMOs, and payers for health insurance. In order to ensure compliance with TG and maintain QOC in a multi-site op, we adapted an electronic medical record (EMR) to evaluate tumor and stage specific compliance in oncology treatments. This report evaluates the OC associated with development and operation of that monitoring system and its application to an HMO patient population of 75,000 covered lives. Methods: OC included 25% (proportion of HMO to total patients )of the emr system developmental costs (DC) and operational costs (OpC). Personnel time included entering data and treatments, training, data coordination, and data analysis. Salaries were based on regional averages for physicians, administrators, clerks, and nurses. Time estimates were made for monitoring quality data only, excluding standard patient care. Compliance data is reported separately. Results: 1,250 patients over 18 months were treated by 5 of the op physicians. DC for this program included computer hardware $25,000, personnel training $10,900, and EMR licensing $12,500. Annualized operational costs (OpC) included emr maintenance fees $1000, IT consultants $4500, physician time to enter individual patient data at first consultation and follow up visits $58,000, nursing time to enter treatment data and continued training $7650, physician continued training $11,250, senior administrator coordination $30,000, administrative supervision $17,900, clerical data analysis $22,500, and senior physician supervision $50,000. Costs per covered life for DC were $0.645 and for OC were $2.704 per year. Conclusions: The costs to maintain QOC and ensure TG compliance are substantial and must be reimbursed by hips and HMOs. Understanding these costs is essential to negotiating care contracts with hips that will monitor care appropriately. Investing in EMR methods to ensure QOC will be important to patients and op, as well as hips. Monitoring continuing OC to determine if they decrease with additional experience is essential. Standardizing EMR data sets aad op methodologies for compliance monitoring will further improve efficiencies and cost efficacy in documenting delivered QOC. No significant financial relationships to disclose.

The paper defines conditions to achieve the national goal of increasing the lifetime in the Russian Federation to 78 years by 2024 as set in Presidential Decree No. 204 of May 7, 2018. The measures proposed in the Healthcare and Demography national projects are analyzed and additional measures to improve public health are proposed. It is shown that because of inadequate government expenditures on medicines for outpatients, the financial burden of their acquisition by people is four times as much compared to the government spending. It was revealed that to achieve life expectancy of 78 years by 2024, the public healthcare per capita expenditures should grow by 15% annually in constant prices, providing that the country’s GRP per capita increases by 1.7% in 2019, by 3% in 2020 and by 4% in the period of 2021–2024, while the consumption of strong alcoholic beverages decreases by 45% per capita. In the Healthcare national project the healthcare expenditure growth rates are defined to be below 10% at current prices. The paper concludes that the achievement of this goal requires additional government expenditures (including those in the framework of the Healthcare national project). The funds should also be directed to expanding the availability of medicines for outpatients, programs for reducing mortality from infectious diseases, and increasing salaries of lower medical personnel. For the implementation of the Demography national project, particular targets should be set to reduce the alcohol consumption by 45% until 2024, with twofold reduction of the proportion of smokers, along with additional measures to implement the anti-alcohol and anti-tobacco policy and promote healthy living among the population.

Background. The main goal of reforming the primary health care system (PHC) is to improve its quality and accessibility. At present, 30.45 million declarations have been signed in Ukraine with 23,453 primary care physicians. More than 70 % of those who signed the declaration are satisfied with their family doctor (FD). All PHC utilities have signed the agreements with the National Health Service of Ukraine. However, only 9 % of respondents considered health care reform successful. Objective. To describe the current condition of PHC reform. Materials and methods. Review of the available statistics and publications on this issue. Results and discussion. High-quality transformation of PHC requires consideration of historical experience, regulatory framework, financial efficiency, organization of quality medical care, effective human resources policy, and social efficiency. The groundwork for the current reform began in 2006, when the concept of the State Program for PHC development was adopted. Since 2010, there is a separate medical specialty “General practice – family medicine”. By 2020, there should be a complete retraining of physicians and pediatricians for FD, who had to take care of 80 % of the patient’s needs. New principles of financing for real patients and the functioning of the system allowing to choose a doctor were implemented only in 2017-2020, and all the imperfections of PHC could not be eliminated. FD should be aware that their competence and the depth of services provided are now particularly important. Another task of the reform is to improve the financial efficiency of PHC: streamlining the budget, providing the feasibility and justification of costs, establishing the free package of guaranteed medical services. The disadvantages of the current financial system are that the re-indexation of doctors’ salaries has not taken place, inflation and rising drug prices have not been taken into account. Apart from that, there are no adjustment factors for rural doctors and payment for home visits. The reasons for inefficient funding are the lack of budgetary resources, the inertia of management in the context of frequent changes in the leadership of the Ministry of Health, non-transparent management of some institutions, negative lobbying by representatives of other sectors of health care. The organization of medical care also does not address a number of issues: there are no national screening programs, no criteria for the quality of work of doctors and nurses, and no mechanism of life and health insurance of medical staff. The eHealth system and the personnel aspects of PHC also need improvement. Thus, in 5 out of 6 outpatient clinics there is a shortage of medical staff. The forced retraining of long-serving physicians has provoked considerable resistance, and some of these physicians have never become FD. Among other issues that need to be addressed are the establishment of interactions between the departments of medical universities and clinical bases, legalization of scientific and pedagogical workers in the system of the National Health Service of Ukraine, payment for the work of interns. In terms of social efficiency, the benefits for the patient are the ability to choose a doctor and a PHC facility, the availability of an electronic queue, free basic services, the ability to communicate with a doctor and order medication online. Disadvantages include problems with medical care in case of temporary absence of a doctor, especially unpredicted, lack of possibility of emergency admission in some institutions, long travel distance to the PHC institution. Conclusions. 1. The main goal of reforming the PHC system is to improve its quality and accessibility. 2. Qualitative transformation of PHC requires taking into account historical experience, regulatory framework, financial efficiency, organization of quality medical care, effective personnel policy, social efficiency. 3. The current PHC system has a number of gaps that should be gradually addressed. 4. Among other issues that need to be addressed – the establishment of interactions between the departments of medical universities with clinical bases, legalization in the system of the National Health Service of Ukraine of scientific and pedagogical workers, payment for the work of interns. 5. The advantages of the modern PHC system for the patient are the ability to choose a doctor and a PHC facility, the availability of an electronic queue, free basic services, the ability to communicate with a doctor and order medication online.

Background: The AMPATH Consortium has served to greatly expand healthcare in western Kenya. Gaps and limitations in care still exist, especially in oncology care in rural areas. Telemedicine provides a lower cost, practical method to maximize physician resources and limit cost and stress to families with socioeconomic limitations in rural Kenya. The following paper seeks to discuss the importance of developing a telemedicine model in western Kenya and the many advantages telemedicine can bring, as well as discuss the telemedicine model being developed by AMPATH Oncology. Aim: Integrate paper-based medical records into the AMPATH AIDS EMR; Identify sustainable telemedicine tools to integrate into the EMR; Establish networking in rural clinics; Budget in IT personnel at each clinic to assist in patient setup with central site; use solar as primary power source for devices to aid in power issues. Only 45% of Kenyans have access to power; Use cellular networks for communication; Maximize time allocated for physicians to see patients; Decrease travel time to clinics as only 32% of Kenyans live in urban environments. Methods: Cost analysis of remote clinic locations and associated costs; Clinic budget estimate for networking and telemedicine support position; Cost summary and savings Results: Estimated costs for the operations budget for the 17 rural outreach clinics include the costs of hardware, solar networking setup, and internet at a total $3400/wk. This will decrease after the first year to $1700 for maintenance costs of equipment. Personnel consists of 1 local person to support the system and will be a weekly cost of $1870. Lost time for physicians due to road travel totals ∼100 hours weekly. Estimated salaries for an oncologist at $30/h leads to a cost of $3007/wk in lost productivity. It should be noted that lodging and per diem expenses are not included in the estimated expenses that total $6114/wk. By doing telemedicine at the rural clinics in an ideal 48 workable week situation. The savings of $528,000 is a clear evidence that this is financially feasible solely based on travel savings over 5 years. For this reason, the actual savings is ∼$264,000 and still makes a strong argument for this being the right move. Conclusion: Telemedicine is a viable and necessary resource for developing oncologic care in rural Kenya. We believe that telemedicine represents a natural evolution in healthcare in Kenya to support its rural population. Telemedicine helps maximize the limited physician resources and allows them to reach a larger audience without tying up their time in lengthy commutes. Last, telemedicine should assist patients to overcome the barriers of cost and time that limit their treatment. Future challenges and gains will be made with the evolution of the newly formed national health insurance system. Gaining support and reimbursement from telemedicine visits will be crucial to ensuring the success of telemedicine.

AbstractObjective:The purpose of this study was to evaluate stress levels in emergency medical services personnel across the United States.Design:Confidential, 20-question survey tool, Medical Personnel Stress Survey-Abbreviated (MPSS-R). A total score of 50 indicates average stress levels. A score of 12.5 on the subset measurements of somatic distress, job dissatisfaction, organizational stress, and negative attitudes towards patients indicates average levels of stress. Data were analyzed using ANOVA and t-test.Interventions:None.Results:A total of 658 of 3,000 emergency medical technicians (EMTs) (22%) completed the survey. The mean value of 69.3±6.3 for the total stress scores was very high Mean values for the subset scores were: somatic distress = 19.6±3.3; organizational stress = 17.3±2.4; job dissatisfaction = 17.0±2.6; negative attitudes towards patients = 15.5±2.3. Characteristics predicting higher stress were EMT-basic (A) licensure, basic life support (BLS) only service provider, volunteer status, new employee working in a small EMS organization, and providing service to a small town.Conclusion:Stress levels in EMS personnel were very high, were manifested primarily as somatic distress, secondarily as organizational stress and job dissatisfaction, and lastly as negative patient attitudes. Stress levels and subset manifestations of occupational stress among EMS personnel varied depending on gender, marital status, age, level of training and function, on salaried or volunteer status, length of time as an EMT, and size of the organization, city, and population served. Care should be taken to address stresses peculiar to individual EMS system needs.

Anesthesiologists, like all other specialists, need to examine carefully their clinical practices so that excessive costs and waste can be reduced without compromising patient care or safety. While costs of drugs used for anesthesia constitute only a small fraction of total health care cost, they are highly visible costs which are easy for administrators to scrutinize. Although cost savings in an individual case may be small, the total savings may be impressive because of the large volume of cases performed. In a recent analysis of strategies to decrease PACU costs, Dexter and Tinker found that anesthesiologists have "little control over PACU economics via the choice of anesthetic drugs". Greater savings could be achieved by timing the arrival of patients into the PACU to reduce the peak requirement of nursing personnel. Hospital and operating room management would be better served by concentrating on these simple measures to improve efficiency rather than forcing anesthesiologists to base drug usage on acquisition costs. Even in countries that have nationalized health services, salaries make up the largest part of the costs, and the expenses in delaying an operation by 30 min exceeds the costs of a 2 h propofol infusion. It is becoming increasingly apparent that attempts at better scheduling of cases, more efficient processing of patients in the PACU to optimize admission rates, and reduced wastage of anesthetic and surgical supplies lead to greater savings than reducing anesthetic-related drug costs. Nevertheless, it is still important for anesthesiologists to participate in the ongoing effort to reduce medical costs without affecting the quality of patient care. Quality care and fiscally sound decision-making are not necessarily mutually exclusive. Simple, effective cost containment measures that all anesthesiologists can practice include using low fresh gas flow rates with inhalation agents and opening sterile packages and drug ampules only if the contents will be used. The choice of an anesthetic agent for routine use depends not only on its demonstrated efficacy and side effect profile, but also on economic factors. It is important to perform careful pharmacoeconomic evaluations of these newer drugs, including assessing all associated costs and benefits for subsets of patients undergoing different types of surgical procedures. These evaluations should also include input from patients regarding their personal preferences. Excessive emphasis on the acquisition costs of drugs may lead to blanket bans on the use of new drugs because of their higher costs rather than permitting physicians to individualize therapy according to their clinical experience and the perceived needs of a given patient. Institutional and individual variations in clinical practices, their associated costs and outcomes may alter conclusions about acceptability and economic evaluation of a particular drug or technique. The information in this review can be used to provide a rational basis for incorporating cost considerations into the decision-making process regarding the drugs, devices and techniques used in anesthesiology.

Background.Before the emergence of the pandemic (H1N1) 2009 virus, estimates of the stockpiles of facial protective equipment (FPE) and the impact that information had on personnel during a pandemic varied.Objective.To describe the impact of H1N1 on FPE use and hospital employee absenteeism.Setting.One tertiary care hospital and 2 community hospitals in the Vancouver Coastal Health (VCH) region, Vancouver, Canada.Patients.All persons with influenza-like illness admitted to the 3 VCH facilities during the period from June 28 through December 19, 2009.Methods.Data on patients and on FPE use were recorded prospectively. Data on salaried employee absenteeism were recorded during the period from August 1 through December 19, 2009.Results.During the study period, 865 patients with influenza-like illness were admitted to the 3 VCH facilities. Of these patients, 149 (17.2%) had laboratory-confirmed H1N1 influenza infection. The mean duration of hospital stay for these patients was 8.9 days, and the mean duration of intensive care unit stay was 9.2 days. A total of 134,281 masks and 173,145 N95 respirators (hereafter referred to as respirators) were used during the 24-week epidemic, double the weekly use of both items, compared with the previous influenza season. A ratio of 3 masks to 4 respirators was observed. Use of disposable eyewear doubled. Absenteeism mirrored the community epidemiologic curve, with a 260% increase in sick calls at the epidemic peak, compared with the nadir.Conclusion.Overall, FPE use more than doubled, compared with the previous influenza season, with respirator use exceeding literature estimates. A significant proportion of FPE resources were used while managing suspected cases. Planners should prepare for at least a doubling in mask and respirator use, and a 3.6-fold increase in staff sick calls.

Objective The purpose of this paper is to report the baseline characteristics of EMPOWER participants—a group of newly diagnosed breast cancer survivors—and describe differences in hourly and salaried wage women’s experiences regarding cancer and work management in the three months following breast cancer diagnosis. Design and setting The EMployment and Potential Outcomes of Working through canceER (EMPOWER) project is a prospective longitudinal, mixed methods pilot study designed to evaluate how employment influences treatment decisions among women diagnosed with breast cancer. Participants were women diagnosed with new breast cancer and treated at one of two clinical sites of the University of Maryland Medical System. Women were enrolled in the study within three months of first breast cancer diagnosis. Study visits occurred every three months for one year. This paper reports data from for the baseline and three-month visit which had been completed by all enrollees. Methods Trained research personnel collected demographic information, medical history and health status, social history, employment data, cancer-related data, psychosocial adjustment, and financial wellbeing at the baseline enrollment visit. A semi-structured qualitative interview was administered at the three-month study visit to assess employment decisions and the impact of job demands, cancer care, and cancer-work fit during the three months following diagnosis. Result Fifty women with new, primary diagnosis of breast cancer were enrolled in the study. Mean age of participants was 51 years, and 46% identified their race as Black or other. The majority of women disclosed their diagnosis to their employer and nearly all maintained some level of employment during the first three to six months of treatment. Women with hourly wage jobs were similar to those with salaried wage jobs with respect to demographic and social characteristics. Women with hourly wage jobs were more likely to report working in physically demanding jobs and taking unpaid leave. They were also more likely to experience side effects that required physical restrictions at work, to leave their jobs due to demands of treatment, and to report managing cancer and work concurrently as very difficult. Women in salaried wage jobs were more likely to report falling behind or missing work and working remotely as a cancer-management strategy. Women in hourly jobs more often reported difficulty managing the competing demands of cancer and work. Conclusion While further study is needed, these results suggest that women in hourly and salaried workers reported similar experiences managing cancer and work, with a few key exceptions. These exceptions pertain to the nature of hourly-wage work. Cancer survivors employed in hourly jobs may be more vulnerable to poor employment outcomes due to limited access to paid time off and workplace flexibility, and challenges related to managing physical aspects of cancer and employment.

As we approach the last quarter of the year, it is time that Fellows of the Philippine Society of Otolaryngology-Head and Neck Surgery (PSOHNS) receive this report from the President and the Board of Trustees. Following the successful staging of the midyear congress at EDSA Shangrila and distribution of the coffeetable book-- another chronicle of our rich history-- we also witnessed the launching of the advocacy campaign “Change is in the Air” led by Philippine Academy of Rhinology (PAR) Chair Dr. Tony Chua with Drs. Mari Enecilla and Joel Romuladez that even saw print in the newspapers. Despite the challenges, the support we received from our pharmaceutical friends was tremendous and the avowed fund support for advocacy from the proceeds of that congress amounting to a little over P2 million will certainly go a long way for our future campaigns. Our new home and headquarters at 27 Manga Road, Quezon City was finally inaugurated last July 8. Legal ownership with the title of the property under the name of PSOHNS has been effected as has been approved by the general assembly with the funds related to our transfer and total expenses for minor renovation and transfer and other taxes amounting to an expenditure of almost P29 million. The tax-exempt certificate filed from our Medical Plaza Ortigas business address will be transferred to Quezon City with the application for a change in business address. There have already been activities, meetings and functions held at our new headquarters. As approved by the Board, we have invited the Philippine Board of Otolaryngology - Head and Neck Surgery (PBOHNS) to hold their meetings there and also hold office in one of the rooms. We expect full transfer by the time this tax-exempt certificate and occupancy permit have been obtained. The work on becoming a recognized specialty by the Philippine Medical Association (PMA) is still a work in progress but the task is in hand more than ever with about 5000 more votes during the last congress and hopefully the final turnover of these votes before the next PMA convention in May 2017 will make the campaign a success. I urge all the Fellows and Chapters to continue to rally their colleagues and use the proxy forms available at the secretariat. We have written the PMA to inform us of the number of votes still needed. It is on record that our society in fact submitted the most number of proxy votes for this campaign during the last PMA convention. Let us all work even harder to make this a reality by May 2017. The Professional Regulations Commission (PRC) and Philippine Regulatory Board of Medicine (PRBOM) required us last May to develop and submit an Outcomes Based Education (OBE) Curriculum. We submitted the required curriculum to the PRBOM led by Dr. Miguel Noche in cooperation and close collaboration with the PBOHNS led by Dr. Rodolfo Nonato through the commendable hard work of Drs. Agnes T. Remulla, Elmo Lago and Ed Alfanta as well as other committed fellows from the different subspecialties and institutions. Welcome changes to the required list and number of procedures for resident trainees as a result of the formulation of this new curriculum were approved. Our core values of Professionalism, Service with Excellence, Outstanding Education and Research, Honor and Integrity, Nationalism and Solidarity stood as pillars that guided the whole process of crafting this OBE. It will now be incumbent upon the institutions to tweak their instructional designs and particular curricula to conform to or even surpass the common minimum standards. We will bring to the table this curriculum and standards when we talk with our Association of South East Asian Nations (ASEAN) counterparts in the move to ASEAN Harmonization and Integration. The next midyear congress will be held in Laoag City under the leadership of Dr. Jose Orosa III. The next Annual Congress will be jointly held with the 10th International Symposium on Recent Advances in Rhinosinusitis and Nasal Polyposis from November 29- December 2, 2017 with PAR and Dr. Gil Vicente as prime mover. The Philippines will also host the 10th Otorhinolaryngology International Academic Conference (ORLIAC) on March 1-3, 2018 with myself as co-chair. The theme will be “East Meets West: The Future of ORLHNS” with Prof. Jan Veldman and Prof. Lokman Saim helping organize this with world renowned ORL clinician-researchers willing to share their expertise on issues relevant to our country and the region. We hope this will inspire our young ENT diplomates and fellows to embark on academic and innovative strategies in the interest of achieving better care in ORLHNS. The 60th Annual Congress at Marriott Grand Ballroom from December 1-3, 2016 will culminate the celebration of our diamond jubilee year. The PSOHNS will host the 6th Pan Asia Academy of Facial Plastic and Reconstructive Surgery in this joint Congress. We are excited at this year’s theme: Restoring Form and Function and the record number of speakers for the congress with its interesting scientific and social programme will be astounding. As we close the year more projects are forthcoming such as the updated Clinical Practice Guidelines (Sleep Surgery has been disseminated with Otitis Media and Sinusitis to follow). On its 35th year, the Philippine Journal of Otolaryngology Head and Neck Surgery’s continued moves toward open access will make our research work more accessible and available to scientific circles worldwide. We have recognized the loyalty and service of our personnel Mia, Sharon, Melissa and Kiko by a windfall increase in salaries and benefits that have long been overdue. We are now in the process of digitizing our records along with other housekeeping functions that we have embarked on this year. We also foresee a constitutional amendment to accommodate an expanded membership programme to be attuned with the mandate and direction of the Philippine Medical Association to be as inclusive as possible. The kind approval of the Fellows in the general assembly meeting is prayed for considering the fact that our scientific calendar and a lot of PSOHNS activities have been geared towards preparing the resident trainees, diplomates and non-diplomates and board eligibles to be dedicated Fellows of PSOHNS in the future, imbued with the core values we so cherish.

Miriam Lopes Costa8RESUMOObjetivo: caracterizar o perfil de pessoas idosas com diabetes acompanhados em seguimento ambulatorial de uma instituição hospitalar utilizando os dados sociodemográficos e clínicos. Método: trata-se de um estudo quantitativo, descritivo, transversal, realizado com 168 idosos. Reuniram-se os dados a partir de entrevista e consulta ao prontuário, submetendo-os às técnicas de estatística descritiva, sendo realizado o teste estatístico Qui-quadrado, e os resultados apresentados em forma de tabelas. Resultados: identificou-se a prevalência três vezes maior do sexo feminino (121=72%); o número de casados foi superior às demais categorias (90=53,6%); metade recebia até um salário mínimo (58=50%); a maioria encontrava-se na faixa de 60 a 69 anos (114=67,9%); o tempo de diagnóstico do diabetes foi superior a 10 anos em 73 (43,5%) entrevistados, sendo a neuropatia diabética a complicação de maior prevalência (97=58,1%). Conclusão: reporta-se, pela realização desse estudo, a uma visão holística de alguns aspectos que são passiveis de intervenções, para a equipe multiprofissional de saúde, a qual cabe-lhe a realização da assistência efetiva e integral visando a atender as necessidades biológicas e psicossociais. Descritores: Idoso; Diabetes Mellitus; Diabetes Mellitus Tipo 2; Autocuidado; Pessoal de Saúde; Assistência Ambulatorial. ABSTRACT Objective: to characterize the profile of elderly people with diabetes followed up at the outpatient clinic of a hospital using socio-demographic and clinical data. Method: this is a quantitative, descriptive, cross-sectional study of 168 elderly people. Data was collected from interviews and consultations of the medical record, subjecting them to descriptive statistics techniques, and the Chi-square statistical test was performed, and the results were presented in the form of tables. Results: a threefold prevalence of the female sex (121 = 72%) was identified; the number of married couples was higher than the other categories (90 = 53.6%); half received a minimum wage (58 = 50%); the majority were in the range of 60 to 69 years (114 = 67.9%); the diagnosis time of diabetes was over ten years in 73 (43.5%) interviewed, with diabetic neuropathy being the most prevalent complication (97 = 58.1%). Conclusion: this study presents a holistic view of some aspects that are possible for interventions for the multiprofessional health team, which is responsible for the effective and integral assistance to meet the biological and psychosocial. Descriptors: Elderly; Diabetes Mellitus; Type 2 Diabetes Mellitus; Self-care; Health Personnel; Ambulatory Care. RESUMEN Objetivo: caracterizar el perfil de personas mayores con diabetes acompañados en seguimiento ambulatorio de una institución hospitalaria utilizando los datos sociodemográficos y clínicos. Método: se trata de un estudio cuantitativo, descriptivo, transversal, realizado con 168 ancianos. Se reunieron los datos a partir de entrevista y consulta al prontuario, sometiéndolos a las técnicas de estadística descriptiva, siendo realizado el test estadístico Qui-cuadrado, y los resultados presentados en forma de tablas. Resultados: se identificó la prevalencia tres veces mayor del sexo femenino (121 = 72%); el número de casados fue superior a las demás categorías (90 = 53,6%); la mitad recibía hasta un salario mínimo (58 = 50%); la mayoría se encontraba en el rango de 60 a 69 años (114 = 67,9%); el tiempo de diagnóstico de la diabetes fue superior a 10 años en 73 (43,5%) entrevistados, siendo la neuropatía diabética la complicación de mayor prevalencia (97 = 58,1%). Conclusión: se reporta, por la realización de este estudio, una visión holística de algunos aspectos que son pasibles de intervenciones, para el equipo multiprofesional de salud, la cual le corresponde la realización de la asistencia efectiva e integral para atender las necesidades biológicas y psicosocial. Descritores: Ancianos; Diabetes Mellitus; Diabetes Mellitus Tipo 2; Autocuidado; Personal de Salud; Atención Ambulatorial.

Abstract 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.

Background: Shortages of Human Resources for Health (HRH) in rural areas are often driven by poor working and living conditions, inadequate salaries and benefits, lack of training and career development opportunities amongst others. The South African government has adopted a human resource strategy for the health sector in 2011 aimed at addressing these challenges.Aim: This study reviews the challenges faced by health personnel against government strategies aimed at attracting and retaining health personnel in these underserved areas.Setting: The study was conducted in six primary health care service sites in the Hlabisa sub-district of Umkhanyakude, located in northern KwaZulu-Natal, South Africa.Methods: The study population comprised 25 health workers including 11 professional nurses, 4 staff nurses and 10 doctors (4 medical doctors, 3 foreign medical doctors and 3 doctors undertaking community service). Qualitative data were collected from semi-structured interviews and analysed using thematic analysis.Results: Government initiatives including the rural allowance, deployment of foreign medical doctors and the presence of health personnel undertaking their community service in rural areas are positively viewed by health personnel working in rural health facilities. However, poor living and working conditions, together with inadequate personal development opportunities, remain unresolved challenges. It is these challenges that will continue to dissuade experienced health personnel from remaining in these underserved areas.Conclusion: South Africa’s HRH strategy for the Health Sector 2012/13–2015/16 had highlighted the key challenges raised by respondents and identified strategies aimed at addressing these challenges. Implementation of these strategies is key to improving both living and working conditions, and providing health personnel with opportunities for further development will require inter-ministerial collaboration if the HRH 2030 objectives are to be realised.

Abstract Background Due to economic development and an increase in the aging population, the demand for medical resources is increasing. A good doctor-patient relationship (DPR) can optimize patients’ medical experience and improve treatment efficiency. The DPR, however, is currently in crisis in China. To explore ways to improve DPR, this study assessed the views on the status of the DPR, medical services, and the general situation of medical work among medical personnel (MP) and the general population (GP). Methods This cross-sectional study, conducted between December 2019 and March 2020, targeted the MP and the GP in Nanjing City, Jiangsu Province, and Zhengzhou City, Henan Province. A total of 154 MP and 329 GP answered a self-administered questionnaire through Questionnaire Star and WeChat apps. Wilcoxon’s Sign Rank Test, Chi-square test, and frequency distributions and percentages were used to process the data. Results Only 11.04% of the MP and 14.89% of the GP believed that the current DPR was harmonious. Moreover, 54.55% of the MP and 71.12% of the GP believed that the medical industry was a service industry. While 14.29% of the MP and 64.44% of the GP thought medical staff earned high salaries, 19.48% of the MP and 47.11% of the GP wanted their children to be in the medical industry. The recognition of the current status of the DPR did not affect the GP’s preference for their children’s practice (p < 0.05). Most MPs hoped to improve salaries (40.26%), followed by safety (17.53%) and social status (12.99%); only 8.44% of the MP wanted to improve the DPR. Conclusion The MP’s and GP’s views on the current status of DPR, the importance of medical service attitudes, and the general sense of the medical industry were similar. However, there was a significant difference in the perception of the nature of medical services and the income of the people employed in the medical industry between the two groups. Balancing the expectations of patients in the medical industry and increasing public awareness of the actual situation in the medical industry may be a feasible way to improve the DPR.

Background: Pre-hospital care plays an important role in managing patients who require emergency services and preserving human life. The aim of this study was to evaluate the cost of completed public pre-hospital emergency missions according to the activity-based costing model and to compare it with the cost of private pre-hospital emergency services in Mashhad in 2016. Methods: In this applied and descriptive cross-sectional study, the data were collected using a researcher-made form 4 major groups of costs were identified to estimate the total costs: 1- Personnel salaries, 2- Current expenses 3- Medical consumables 4- Depreciation. The cost of providing pre-hospital services was calculated based on the activity-based costing. Eventually, the cost of pre-hospital emergency services was compared between the public and private sectors. To investigate the cost-effective factors for missions, multiple regression analysis, Breusch-Pagan, Ramsey RESET, Swilk, and Linktest diagnostic tests were used by Stata 11.0 software. Results: The average cost of each mission was equal to 2114337 ± 217786 thousand Rials in 58 emergency medical centers of Mashhad in 2016. Of this cost, 78.51 %, (1660129 ± 1578445 Rials) was related to employees' salaries, 19.24 % (406842 ± 375083 Rials) was related to the current costs of each center, 0.23 % (4796 ± 4476 Rials) was related to depreciation, and 2/02 % (42761 ± 42822 Rials) was related to medical consumables in each pre-hospital emergency mission. The value of contract with an emergency pre-hospital emergency was 1104000 Rials for each mission in 2016, which is almost half of the cost related to the public pre-hospital. Results of the regression model estimation also showed that among the variables of the model, the fuel cost variable was identified as an effective variable on the cost of each mission (p = 0.0001). Conclusion: The private sector provides pre-hospital emergency services at a lower cost. Moreover, before establishing a pre-hospital pre-service center, the cost-effectiveness of establishing a center in each region should be checked.

The article analyzes the state of the health sector in the Russian Federation in the regions of the North Caucasus Federal District, reveals the level and reasons of inequality in the capacity of medicine in federal districts and regions, identifies the main directions for the development and reforming the healthcare system in the country and the subjects of the North Caucasus Federal District. The complex comparative analysis of the state and dynamics of the development of the healthcare in Russia and the regions of the North Caucasus Federal District made it possible to reveal the current challenges, causes and areas of backwardness, and to justify the need to overcome health inequalities in the subjects of the North Caucasus. It has been stated that in recent years there has been observed a positive trend in the development of healthcare in Russia and in the regions of the North Caucasus Federal District. However, the District with its constituent entities are far behind the average indicators of Russia and other federal districts and entities in terms of the level and rates of development of health care. The slowdown is observed at the level of development of the material and technical base, personnel and resource support, per capita financing and salaries of medical personnel. The overall gap in health care is reflected in the health indicators of the population. In the regions of the North Caucasus, the growth rate of the life expectancy is much lower, and the morbidity and mortality rates of the population, including infant mortality, are higher than the national average. There has been suggested measures of gradual reforming health care system to overcome the gap, which corresponds to the general provisions of the RF Presidential Order No. 598 of May 7, 2012 “On improving state policy in health care”

Problem setting. It is important to assess the compliance of the results of the decentralization reform in Ukraine with the population expectations regarding the changes caused by the reform, in particular, the formation of amalgamated territorial communities (ATCs). Attention should be paid to identifying social and economic problems that require further measures to solve them.Recent research and publications analysis. Administrative reforms are continuous in each country and provide for identifying shortcomings and upgrading public administration. Ukrainian scientists proposed a method for assessing the impact of administrative and financial decentralization mechanisms on the social and economic development of regions, districts, cities, and territorial communities. Experts and scientists analyzed the implementation of projects in decentralization, compared Ukrainian and foreign decentralization models.Highlighting previously unsettled parts of the general problem. An important task in terms of the future social and economic development of Ukraine is identifying problems that are still unresolved or are due to the process of decentralization of power in Ukraine. The article is to reveal such problems based on the assessment analysis of this process.Paper main body. Decentralization of power is considered one of the most successful reforms in Ukraine implemented after 2014. The success was based on the clarity of intentions announced by the authorities, the interest of communities in obtaining greater resources and powers, as well as their ability to implement their local development initiatives. A network of Administrative Service Centers (ASCs) has been developed in Ukraine, which can be considered an important achievement of the administrative reform. However, 46–63% of respondents noted a deterioration in the following areas: combating corruption in government; care for vulnerable groups (pensioners, disabled persons); medical care; providing jobs, and combating unemployment. The problems of newly created ATCs included: lack of qualified personnel; strengthening political monopolies that control resources in communities; phenomena when some ATC leaders felt permissive in their new status. Although the number of full-time employees in ATC self-government bodies has generally decreased compared to the total number of employees in the bodies of non-integrated settlements, “inflating” of the salaries of officials takes place.The survey in 2020 reflected the people’s opinion that decentralization of power has led to a deterioration in environmental protection management. The analysis showed that the opinions of respondents on the priority of environmental protection tasks differ significantly depending on their level of education. In particular, when people were asked about the powers that should be primarily exercised by local governments, the distribution of answers on “Environmental Protection” was as follows among the educational social groups: incomplete secondary and lower – 9,9%, full secondary – 19,8%, secondary vocational – 18,4%, and higher – 26,7%. This might be influenced by the amount of environmental knowledge gained. The coronavirus pandemic has apparently led to the creation of conditions for improving the health situation which, according to the new local governments, is one of their key priorities.Conclusions of the research and prospects for further studies. Based on the research results by reputable organizations, the following general social and economic problems have been identified that need to be solved: corruption in government; social vulnerability of pensioners and disabled persons; insufficiently effective medical care; unemployment; armed conflict in eastern Ukraine; and improper environmental management. Problems of some newly created ATCs included: lack of qualified personnel; “inflating” the salaries of officials; strengthening political monopolies that control resources in communities; a sense of permissiveness of “local princes”; lack of a clear list of measures in case of epidemics, natural or man-made disasters; and lack of projects designed to stimulate long-term community development.

Abstract: Objective: Presenteeism is an expensive and challenging problem in the healthcare industry. In anticipation of the staffing challenges expected with the COVID-19 pandemic, we examined a decade of payroll data for a healthcare workforce. We aimed to determine the effect of seasonal influenza-like illness (ILI) on absences to support COVID-19 staffing plans. Design: Retrospective cohort study. Setting: Large academic medical center in the United States. Participants: Employees of the academic medical center who were on payroll between the years of 2009 and 2019. Methods: Biweekly institutional payroll data was evaluated for unscheduled absences as a marker for acute illness-related work absences. Linear regression models, stratified by payroll status (salaried vs hourly employees) were developed for unscheduled absences as a function of local ILI. Results: Both hours worked and unscheduled absences were significantly related to the community prevalence of influenza-like illness in our cohort. These effects were stronger in hourly employees. Conclusions: Organizations should target their messaging at encouraging salaried staff to stay home when ill.

The implementation by regional authorities of the social decrees of the President of Russia adopted in May 2012 is considered in this study. Monitoring of the implementation of Presidential decrees, carried out by various regional state structures, provides the population of the region with a one-sided picture of achieving the targets set by decrees. One of the effective methods in obtaining reliable information is public monitoring, the importance of which has been repeatedly noted at the state level. To assess the implementation of the Presidents decree, according to which the salary of a certain category of personnel should be no less than the average in the region, the author, as a social activist, used data on the performance of institutions open for evaluation by the public and posted on the Official Website of the Russian Federation. At the stage of preliminary analysis, the author extracted data from photocopies of reports and presented in a structured form on the Internet for public study. The objects of observation in this work were the healthcare institutions of the Irkutsk region. The subject of the assessment was the average salary level for doctors and medical personnel. The approach to calculating indicators for assessing the achievement of the level of wages of certain categories of employees of the public sector defined by the relevant decree was based on the principle used in the analysis of differentiation of incomes of the population. The average wage, average modal and average median wage calculated on this principle not only confirmed the fact that the target indicators were not achieved, which is also reflected in the Rosstat data, but also indicated a significant gap between the minimum average wages and the maximum. Based on the data obtained, the author of the study concluded that the information published by the executive authorities of the Irkutsk region was unreliable, according to which the average wages of certain categories of health workers reached the average wage in the region. As a result of a public assessment of the average wage level, the opposite was established - only in half of the doctors and nurses of healthcare institutions in the Irkutsk Region the average wage in 2018 reached the levels established by the relevant decree. The approach proposed in the article to assessing the level of salaries in the healthcare sector can also be used to conduct a public assessment of the level of average salaries in the field of education and culture.В данном исследовании рассматриваются некоторые вопросы исполнения региональными органами власти социальных указов Президента РФ, принятых в мае 2012 г. Мониторинг исполнения осуществления указов Президента РФ, производимый различными региональными государственными структурами, представляет населению региона однобокую картину достижения целевых показателей, заданных указами. К одному из действенных методов в получении достоверной информации относится общественный мониторинг, о важности которого не раз отмечалось на государственном уровне. Для проведения оценки исполнения указа Президента РФ, согласно которому заработная плата определенной категории персонала должна быть не менее средней по региону, автором как общественником использовались открытые для оценки данные о результатах деятельности учреждений, размещенные на официальном сайте Федеральной службы государственной статистики. На этапе предварительного анализа автором были извлечены данные из фотокопий отчетов учреждений о средней заработной плате сотрудников учреждений за 2018 г. и представлены в структурированном виде в сети Интернет для общественного изучения. Объектами наблюдения в данной работе стали учреждения здравоохранения Иркутской области. Предметом оценки выбран уровень средней заработной платы врачей и медицинского персонала. В основу подхода к расчету показателей для оценки достижения уровня заработных плат отдельных категорий работников бюджетной сферы, определенных соответствующим указом, был положен принцип, используемый при анализе дифференциации доходов населения. Рассчитанные по этому принципу показатели средней заработной платы, средней модальной и средней медианной заработной платы не только подтвердили факт недостижения целевых показателей, отраженный также и в данных официального сайта для размещения информации о государственных (муниципальных) учреждениях, но и указали на значительный разрыв между минимальными средними зарплатами и максимальными. На основе полученных данных автором исследования были сделаны выводы о недостоверности публикуемых органами исполнительной власти Иркутской области сведений, согласно которым средние заработные платы отдельных категорий работников сферы здравоохранения достигли установленных указом целевых показателей в полном объеме. В результате проведенной общественной оценки уровня средней заработной платы было установлено обратное только у половины врачей и медсестер учреждений здравоохранения Иркутской области средняя заработная плата в 2018 г. достигла установленных соответствующим указом показателей. Предложенный в статье подход к оценке уровня заработных плат в сфере здравоохранения может также использоваться для проведения общественной оценки уровня средних заработных плат в сфере образования и культуры.

Introducción. El número de profesionales de la salud diagnosticados con síndrome de burnout es cada día mayor. En la actualidad, en Colombia las instituciones de salud no están obligadas a pagarles salarios durante su entrenamiento. Además, aparte de sus gastos de manutención, los residentes deben pagar matrícula, lo que puede constituir un factor de estrés que contribuye al desarrollo de burnout. Objetivo. Medir la prevalencia de síndrome de burnout e identificar su posible asociación con diversos factores socioeconómicos en residentes matriculados en programas de residencia ofrecidos por la facultad de medicina de una universidad pública en 2019. Materiales y métodos. Estudio transversal realizado en 269 residentes con un tiempo mínimo de matrícula de 6 meses, y que, según su residencia, fueron clasificados en dos grupos: especialidades clínicas y quirúrgicas. Los datos demográficos y socioeconómicos se recolectaron mediante un cuestionario diseñado para tal fin; además, para el diagnóstico de burnout se utilizó la versión en español del instrumento Maslach Burnout Inventory - Human Services Survey for Medical Personnel (MBI-HSS MP). Los datos se analizaron mediante estadística descriptiva y las asociaciones entre los datos socioeconómicos y los puntajes obtenidos en el MBI se determinaron con la prueba de chi-cuadrado. Resultados. La prevalencia de burnout fue de 39.78%. De igual forma, se observó que su ocurrencia se asoció positivamente con no tener fondos suficientes para costear los gastos asociados con la formación médica de la residencia (OR: 3.45, IC:2.04-5.82), y con haber experimentado eventos de gran importancia o haber presentado problemas de salud en los últimos seis meses (OR: 1.84, IC:1.07-3.14; y OR: 1.81, IC:1.09-3.01, respectivamente). Conclusión. El síndrome de burnout es una condición prevalente en la población estudiada. De esta forma, hasta que la obligación de pagar un salario a los residentes entre en vigencia en Colombia, los programas de residencia deben estar al tanto de este problema y realizar varias modificaciones dirigidas a asegurar su bienestar.

Introduction: Bubbles and Sport The ephemeral materiality of bubbles – beautiful, spectacular, and distracting but ultimately fragile – when applied to protect or conserve in the interests of sport-media profit, creates conditions that exacerbate existing inequalities in sport and society. Bubbles are usually something to watch, admire, and chase after in their brief yet shiny lives. There is supposed to be, technically, nothing inside them other than one or more gasses, and yet we constantly refer to people and objects being inside bubbles. The metaphor of the bubble has been used to describe the life of celebrities, politicians in purpose-built capital cities like Canberra, and even leftist, environmentally activist urban dwellers. The metaphorical and material qualities of bubbles are aligned—they cannot be easily captured and are liable to change at any time. In this article we address the metaphorical sporting bubble, which is often evoked in describing life in professional sport. This is a vernacular term used to capture and condemn the conditions of life of elite sportspeople (usually men), most commonly after there has been a sport-related scandal, especially of a sexual nature (Rowe). It is frequently paired with connotatively loaded adjectives like pampered and indulged. The sporting bubble is rarely interrogated in academic literature, the concept largely being left to the media and moral entrepreneurs. It is represented as involving a highly privileged but also pressurised life for those who live inside it. A sporting bubble is a world constructed for its most prized inhabitants that enables them to be protected from insurgents and to set the terms of their encounters with others, especially sport fans and disciplinary agents of the state. The Covid-19 pandemic both reinforced and reconfigured the operational concept of the bubble, re-arranging tensions between safety (protecting athletes) and fragility (short careers, risks of injury, etc.) for those within, while safeguarding those without from bubble contagion. Privilege and Precarity Bubble-induced social isolation, critics argue, encourages a loss of perspective among those under its protection, an entitled disconnection from the usual rules and responsibilities of everyday life. For this reason, the denizens of the sporting bubble are seen as being at risk to themselves and, more troublingly, to those allowed temporarily to penetrate it, especially young women who are first exploited by and then ejected from it (Benedict). There are many well-documented cases of professional male athletes “behaving badly” and trying to rely on institutional status and various versions of the sporting bubble for shelter (Flood and Dyson; Reel and Crouch; Wade). In the age of mobile and social media, it is increasingly difficult to keep misbehaviour in-house, resulting in a slew of media stories about, for example, drunkenness and sexual misconduct, such as when then-Sydney Roosters co-captain Mitchell Pearce was suspended and fined in 2016 after being filmed trying to force an unwanted kiss on a woman and then simulating a lewd act with her dog while drunk. There is contestation between those who condemn such behaviour as aberrant and those who regard it as the conventional expression of youthful masculinity as part of the familiar “boys will be boys” dictum. The latter naturalise an inequitable gender order, frequently treating sportsmen as victims of predatory women, and ignoring asymmetries of power between men and women, especially in homosocial environments (Toffoletti). For those in the sporting bubble (predominantly elite sportsmen and highly paid executives, also mostly men, with an array of service staff of both sexes moving in and out of it), life is reflected for those being protected via an array of screens (small screens in homes and indoor places of entertainment, and even smaller screens on theirs and others’ phones, as well as huge screens at sport events). These male sport stars are paid handsomely to use their skill and strength to perform for the sporting codes, their every facial expression and bodily action watched by the media and relayed to audiences. This is often a precarious existence, the usually brief career of an athlete worker being dependent on health, luck, age, successful competition with rivals, networks, and club and coach preferences. There is a large, aspirational reserve army of athletes vying to play at the elite level, despite risks of injury and invasive, life-changing medical interventions. Responsibility for avoiding performance and image enhancing drugs (PIEDs) also weighs heavily on their shoulders (Connor). Professional sportspeople, in their more reflective moments, know that their time in the limelight will soon be up, meaning that getting a ticket to the sporting bubble, even for a short time, can make all the difference to their post-sport lives and those of their families. The most vulnerable of the small minority of participants in sport who make a good, short-term living from it are those for whom, in the absence of quality education and prior social status, it is their sole likely means of upward social mobility (Spaaij). Elite sport performers are surrounded by minders, doctors, fitness instructors, therapists, coaches, advisors and other service personnel, all supporting athletes to stay focussed on and maximise performance quality to satisfy co-present crowds, broadcasters, sponsors, sports bodies and mass media audiences. The shield offered by the sporting bubble supports the teleological win-at-all-costs mentality of professional sport. The stakes are high, with athlete and executive salaries, sponsorships and broadcasting deals entangled in a complex web of investments in keeping the “talent” pivotal to the “attention economy” (Davenport and Beck)—the players that provide the content for sale—in top form. Yet, the bubble cannot be entirely secured and poor behaviour or performance can have devastating effects, including permanent injury or disability, mental illness and loss of reputation (Rowe, “Scandals and Sport”). Given this fragile materiality of the sporting bubble, it is striking that, in response to the sudden shutdown following the economic and health crisis caused by the 2020 global pandemic, the leaders of professional sport decided to create more of them and seek to seal the metaphorical and material space with unprecedented efficiency. The outcome was a multi-sided tale of mobility, confinement, capital, labour, and the gendering of sport and society. The Covid-19 Gilded Cage Sociologists such as Zygmunt Bauman and John Urry have analysed the socio-politics of mobilities, whereby some people in the world, such as tourists, can traverse the globe at their leisure, while others remain fixed in geographical space because they lack the means to be mobile or, in contrast, are involuntarily displaced by war, so-called “ethnic cleansing”, famine, poverty or environmental degradation. The Covid-19 global pandemic re-framed these matters of mobilities (Rowe, “Subjecting Pandemic Sport”), with conventional moving around—between houses, businesses, cities, regions and countries—suddenly subjected to the imperative to be static and, in perniciously unreflective technocratic discourse, “socially distanced” (when what was actually meant was to be “physically distanced”). The late-twentieth century analysis of the “risk society” by Ulrich Beck, in which the mysterious consequences of humans’ predation on their environment are visited upon them with terrifying force, was dramatically realised with the coming of Covid-19. In another iteration of the metaphor, it burst the bubble of twenty-first century global sport. What we today call sport was formed through the process of sportisation (Maguire), whereby hyper-local, folk physical play was reconfigured as multi-spatial industrialised sport in modernity, becoming increasingly reliant on individual athletes and teams travelling across the landscape and well over the horizon. Co-present crowds were, in turn, overshadowed in the sport economy when sport events were taken to much larger, dispersed audiences via the media, especially in broadcast mode (Nicholson, Kerr, and Sherwood). This lucrative mediation of professional sport, though, came with an unforgiving obligation to generate an uninterrupted supply of spectacular live sport content. The pandemic closed down most sports events and those that did take place lacked the crucial participation of the co-present crowd to provide the requisite event atmosphere demanded by those viewers accustomed to a sense of occasion. Instead, they received a strange spectacle of sport performers operating in empty “cathedrals”, often with a “faked” crowd presence. The mediated sport spectacle under the pandemic involved cardboard cut-out and sex doll spectators, Zoom images of fans on large screens, and sampled sounds of the crowd recycled from sport video games. Confected co-presence produced simulacra of the “real” as Baudrillardian visions came to life. The sporting bubble had become even more remote. For elite sportspeople routinely isolated from the “common people”, the live sport encounter offered some sensory experience of the social – the sounds, sights and even smells of the crowd. Now the sporting bubble closed in on an already insulated and insular existence. It exposed the irony of the bubble as a sign of both privileged mobility and incarcerated athlete work, both refuge and prison. Its logic of contagion also turned a structure intended to protect those inside from those outside into, as already observed, a mechanism to manage the threat of insiders to outsiders. In Australia, as in many other countries, the populace was enjoined by governments and health authorities to help prevent the spread of Covid-19 through isolation and immobility. There were various exceptions, principally those classified as essential workers, a heterogeneous cohort ranging from supermarket shelf stackers to pharmacists. People in the cultural, leisure and sports industries, including musicians, actors, and athletes, were not counted among this crucial labour force. Indeed, the performing arts (including dance, theatre and music) were put on ice with quite devastating effects on the livelihoods and wellbeing of those involved. So, with all major sports shut down (the exception being horse racing, which received the benefit both of government subsidies and expanding online gambling revenue), sport organisations began to represent themselves as essential services that could help sustain collective mental and even spiritual wellbeing. This case was made most aggressively by Australian Rugby League Commission Chairman, Peter V’landys, in contending that “an Australia without rugby league is not Australia”. In similar vein, prominent sport and media figure Phil Gould insisted, when describing rugby league fans in Western Sydney’s Penrith, “they’re lost, because the football’s not on … . It holds their families together. People don’t understand that … . Their life begins in the second week of March, and it ends in October”. Despite misgivings about public safety and equality before the pandemic regime, sporting bubbles were allowed to form, re-form and circulate. The indefinite shutdown of the National Rugby League (NRL) on 23 March 2020 was followed after negotiation between multiple entities by its reopening on 28 May 2020. The competition included a team from another nation-state (the Warriors from Aotearoa/New Zealand) in creating an international sporting bubble on the Central Coast of New South Wales, separating them from their families and friends across the Tasman Sea. Appeals to the mental health of fans and the importance of the NRL to myths of “Australianness” notwithstanding, the league had not prudently maintained a financial reserve and so could not afford to shut down for long. Significant gambling revenue for leagues like the NRL and Australian Football League (AFL) also influenced the push to return to sport business as usual. Sport contests were needed in order to exploit the gambling opportunities – especially online and mobile – stimulated by home “confinement”. During the coronavirus lockdowns, Australians’ weekly spending on gambling went up by 142 per cent, and the NRL earned significantly more than usual from gambling revenue—potentially $10 million above forecasts for 2020. Despite the clear financial imperative at play, including heavy reliance on gambling, sporting bubble-making involved special licence. The state of Queensland, which had pursued a hard-line approach by closing its borders for most of those wishing to cross them for biographical landmark events like family funerals and even for medical treatment in border communities, became “the nation's sporting hub”. Queensland became the home of most teams of the men’s AFL (notably the women’s AFLW season having been cancelled) following a large Covid-19 second wave in Melbourne. The women’s National Netball League was based exclusively in Queensland. This state, which for the first time hosted the AFL Grand Final, deployed sport as a tool in both national sports tourism marketing and internal pre-election politics, sponsoring a documentary, The Sporting Bubble 2020, via its Tourism and Events arm. While Queensland became the larger bubble incorporating many other sporting bubbles, both the AFL and the NRL had versions of the “fly in, fly out” labour rhythms conventionally associated with the mining industry in remote and regional areas. In this instance, though, the bubble experience did not involve long stays in miners’ camps or even the one-night hotel stopovers familiar to the popular music and sport industries. Here, the bubble moved, usually by plane, to fulfil the requirements of a live sport “gig”, whereupon it was immediately returned to its more solid bubble hub or to domestic self-isolation. In the space created between disciplined expectation and deplored non-compliance, the sporting bubble inevitably became the scrutinised object and subject of scandal. Sporting Bubble Scandals While people with a very low risk of spreading Covid-19 (coming from areas with no active cases) were denied entry to Queensland for even the most serious of reasons (for example, the death of a child), images of AFL players and their families socialising and enjoying swimming at the Royal Pines Resort sporting bubble crossed our screens. Yet, despite their (players’, officials’ and families’) relative privilege and freedom of movement under the AFL Covid-Safe Plan, some players and others inside the bubble were involved in “scandals”. Most notable was the case of a drunken brawl outside a Gold Coast strip club which led to two Richmond players being “banished”, suspended for 10 matches, and the club fined $100,000. But it was not only players who breached Covid-19 bubble protocols: Collingwood coaches Nathan Buckley and Brenton Sanderson paid the $50,000 fine imposed on the club for playing tennis in Perth outside their bubble, while Richmond was fined $45,000 after Brooke Cotchin, wife of team captain Trent, posted an image to Instagram of a Gold Coast day spa that she had visited outside the “hub” (the institutionally preferred term for bubble). She was subsequently distressed after being trolled. Also of concern was the lack of physical distancing, and the range of people allowed into the sporting bubble, including babysitters, grandparents, and swimming coaches (for children). There were other cases of players being caught leaving the bubble to attend parties and sharing videos of their “antics” on social media. Biosecurity breaches of bubbles by players occurred relatively frequently, with stern words from both the AFL and NRL leaders (and their clubs) and fines accumulating in the thousands of dollars. Some people were also caught sneaking into bubbles, with Lekahni Pearce, the girlfriend of Swans player Elijah Taylor, stating that it was easy in Perth, “no security, I didn’t see a security guard” (in Barron, Stevens, and Zaczek) (a month later, outside the bubble, they had broken up and he pled guilty to unlawfully assaulting her; Ramsey). Flouting the rules, despite stern threats from government, did not lead to any bubble being popped. The sport-media machine powering sporting bubbles continued to run, the attendant emotional or health risks accepted in the name of national cultural therapy, while sponsorship, advertising and gambling revenue continued to accumulate mostly for the benefit of men. Gendering Sporting Bubbles Designed as biosecurity structures to maintain the supply of media-sport content, keep players and other vital cogs of the machine running smoothly, and to exclude Covid-19, sporting bubbles were, in their most advanced form, exclusive luxury camps that illuminated the elevated socio-cultural status of sportsmen. The ongoing inequalities between men’s and women’s sport in Australia and around the world were clearly in evidence, as well as the politics of gender whereby women are obliged to “care” and men are enabled to be “careless” – or at least to manage carefully their “duty of care”. In Australia, the only sport for women that continued during the height of the Covid-19 lockdown was netball, which operated in a bubble that was one of sacrifice rather than privilege. With minimum salaries of only $30,000 – significantly less than the lowest-paid “rookies” in the AFL – and some being mothers of small children and/or with professional jobs juggled alongside their netball careers, these elite sportswomen wanted to continue to play despite the personal inconvenience or cost (Pavlidis). Not one breach of the netballers out of the bubble was reported, indicating that they took their responsibilities with appropriate seriousness and, perhaps, were subjected to less scrutiny than the sportsmen accustomed to attracting front-page headlines. National Netball League (also known after its Queensland-based naming rights sponsor as Suncorp Super Netball) players could be regarded as fortunate to have the opportunity to be in a bubble and to participate in their competition. The NRL Women’s (NRLW) Premiership season was also completed, but only involved four teams subject to fly in, fly out and bubble arrangements, and being played in so-called curtain-raiser games for the NRL. As noted earlier, the AFLW season was truncated, despite all the prior training and sacrifice required of its players. Similarly, because of their resource advantages, the UK men’s and boy’s top six tiers of association football were allowed to continue during lockdown, compared to only two for women and girls. In the United States, inequalities between men’s and women’s sports were clearly demonstrated by the conditions afforded to those elite sportswomen inside the Women’s National Basketball Association (WNBA) sport bubble in the IMG Academy in Florida. Players shared photos of rodent traps in their rooms, insect traps under their mattresses, inedible food and blocked plumbing in their bubble accommodation. These conditions were a far cry from the luxury usually afforded elite sportsmen, including in Florida’s Walt Disney World for the men’s NBA, and is just one of the many instances of how gendered inequality was both reproduced and exacerbated by Covid-19. Bursting the Bubble As we have seen, governments and corporate leaders in sport were able to create material and metaphorical bubbles during the Covid-19 lockdown in order to transmit stadium sport contests into home spaces. The rationale was the importance of sport to national identity, belonging and the routines and rhythms of life. But for whom? Many women, who still carry the major responsibilities of “care”, found that Covid-19 intensified the affective relations and gendered inequities of “home” as a leisure site (Fullagar and Pavlidis). Rates of domestic violence surged, and many women experienced significant anxiety and depression related to the stress of home confinement and home schooling. During the pandemic, women were also more likely to experience the stress and trauma of being first responders, witnessing virus-related sickness and death as the majority of nurses and care workers. They also bore the brunt of much of the economic and employment loss during this time. Also, as noted above, livelihoods in the arts and cultural sector did not receive the benefits of the “bubble”, despite having a comparable claim to sport in contributing significantly to societal wellbeing. This sector’s workforce is substantially female, although men dominate its senior roles. Despite these inequalities, after the late March to May hiatus, many elite male sportsmen – and some sportswomen - operated in a bubble. Moving in and out of them was not easy. Life inside could be mentally stressful (especially in long stays of up to 150 days in sports like cricket), and tabloid and social media troll punishment awaited those who were caught going “over the fence”. But, life in the sporting bubble was generally preferable to the daily realities of those afflicted by the trauma arising from forced home confinement, and for whom watching moving sports images was scant compensation for compulsory immobility. The ethical foundation of the sparkly, ephemeral fantasy of the sporting bubble is questionable when it is placed in the service of a voracious “media sports cultural complex” (Rowe, Global Media Sport) that consumes sport labour power and rolls back progress in gender relations as a default response to a global pandemic. Covid-19 dramatically highlighted social inequalities in many areas of life, including medical care, work, and sport. For the small minority of people involved in sport who are elite professionals, the only thing worse than being in a sporting bubble during the pandemic was not being in one, as being outside precluded their participation. Being inside the bubble was a privilege, albeit a dubious one. But, as in wider society, not all sporting bubbles are created equal. Some are more opulent than others, and the experiences of the supporting and the supported can be very different. The surface of the sporting bubble may be impermanent, but when its interior is opened up to scrutiny, it reveals some very durable structures of inequality. Bubbles are made to burst. They are, by nature, temporary, translucent structures created as spectacles. As a form of luminosity, bubbles “allow a thing or object to exist only as a flash, sparkle or shimmer” (Deleuze, 52). In echoing Deleuze, Angela McRobbie (54) argues that luminosity “softens and disguises the regulative dynamics of neoliberal society”. The sporting bubble was designed to discharge that function for those millions rendered immobile by home confinement legislation in Australia and around the world, who were having to deal with the associated trauma, risk and disadvantage. 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