State of Physician Unionization.

OBJECTIVES: To provide an overview of the current state of physician unionization, potential factors surrounding increased unionization, and the ethical and financial issues that may arise. DESIGN: Review article. SETTING: Not applicable. PARTICIPANTS: Not applicable. RESULTS: Over the last few years, there has been a recent surge in physician unionization. Union membership among residents and fellows is also at an all-time high and continues to increase, as seven residency programs voted to unionize in 2023. The resulting threat of strikes has grown considerably over the last year as residents across 6 hospitals have threatened to strike, resulting in New York's first physician strike in over three decades. As physician practice continues to shift from private to corporate health system-based employment, more opportunities for unionization will arise. Globally, these trends have been comparable, with thousands of physicians striking across the United Kingdom, Germany, Italy, Nigeria, and New Zealand in the last year. CONCLUSION: The current state of physician unionization is of increasing significance as more physicians are presented with opportunities for unionization. Physicians perceive a lack of autonomy, and the demand to deliver high level outcomes with diminishing resources is becoming an insurmountable challenge. Additionally, physician satisfaction with their workplace has decreased with increased burnout rates. Thus, it is important to understand the current state of unionization, potential reasons for unionization among physicians and residents, and its future impact on the field of medicine.

Orthobiologics in delayed union and non-union of adult long bones fractures: A systematic review.

Background: Fracture healing poses a significant challenge in orthopedics. Successful regeneration of bone is provided by mechanical stability and a favorable biological microenvironment. This systematic review aims to explore the clinical application of orthobiologics in treating aseptic delayed union and non-union of long bones in adults. Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Three databases were explored, with no date restrictions, using keywords related to orthobiologics and delayed union and non-union. Eligible studies included human clinical studies in English, with available full texts, examining orthobiologics such as platelet-rich plasma (PRP), mesenchymal stem cells (MSCs), and bone morphogenetic protein (BMPs) for treating aseptic delayed unions and non-unions in adults. Animal studies, in vitro research, and studies on non-unions due to congenital defects, tumors or infections were excluded. Results: The initial search identified 9417 studies, with 20 ultimately included in the review. These studies involved 493 patients affected by non-union and 256 patients affected by delayed union, with an average age respectively of 40.62 years and 41.7 years. The mean follow-up period was 15.55 months for non-unions and 8.07 months for delayed unions. PRP was the most used orthobiologic, and outcomes were evaluated through time to union, functional scores, and clinical examinations. The results indicated that orthobiologics, especially PRP, tended to yield better outcomes compared to surgical procedures without biological factors. Conclusion: This systematic review suggests that orthobiologics, such as PRP, BMPs, and MSCs, can be effective and safe in the management of delayed union and non-union fractures. These biological treatments have the potential to improve union rates, reduce healing times, and enhance functional outcomes in patients with non-union fractures. Further research is essential to refine treatment protocols and determine the most suitable orthobiologic for specific patient populations and fracture types.

Correcting misperceptions of the material benefits associated with union membership increases Americans' interest in joining unions.

How accurate are Americans' perceptions of the material benefits associated with union membership, and do these perceptions influence their support for, and interest in joining, unions? We explore these questions in a preregistered, survey experiment conducted on a national sample, representative of the US population on a number of demographic benchmarks (n = 1,430). We find that Americans exhibit large and consistent underestimates of the benefits associated with unionization, as compared to evidence from the Bureau of Labor Statistics and peer-reviewed academic research. For example, 89% of Americans underestimated the life-time income premium associated with union membership, 72% underestimated the percentage of union members who receive health insurance from their employer, and 97% overestimated the average union dues rate. We next randomly assigned half of the participants to receive a brief, informational correction conveying results of academic and government research on the material benefits associated with union membership, or not. Those who received the correction reported 11.6% greater interest in joining a union, 7.8% greater support for unions, and 6.9% greater interest in helping to organize a union in their workplace, as compared to the control group. These results suggest that, overall, Americans tend to underestimate the material benefits associated with unionization, misperceptions of these benefits are causally linked to Americans' support for unionization, and correcting these misperceptions increases a range of pro-union sentiments in the American mass public.

Bread or roses? Trade unions, female employment and the expansion of work-family policies.

In the Fordist era, trade unions promoted welfare state expansion and coverage against risks for the broader workforce. With the shift to the post-industrial economy, however, new economic groups have been left without representation. This is particularly evident for women: despite a rapid increase in female employment since the 1980s, unions' membership base remains anchored in the male, old and industrial working class. Without the crucial pressure of labour, welfare systems have failed to enhance the reconciliation of work and family life. Under which conditions do unions support the expansion of work-family policies? Marshalling evidence from 20 OECD countries in the 1980-2010 period, this paper investigates the role of political actors in family policy reform. Findings suggest that unions promote the expansion of work-family packages when they are gender-inclusive and have institutional access to policy-making.

Managing under austerity: a qualitative study of management-union relations during attempts to cut labour costs in three South African public hospitals.

PURPOSE: In this paper, the authors examine the strategies used to reduce labour costs in three public hospitals in South Africa, which were effective and why. In the democratic era, after the revelations of large-scale corruption, the authors ask whether their case studies provide lessons for how public service institutions might re-make themselves, under circumstances of austerity. DESIGN/METHODOLOGY/APPROACH: A comparative qualitative case study approach, collecting data using a combination of interviews with managers, focus group discussions and interviews with shop stewards and staff was used. FINDINGS: Management in two hospitals relied on their financial power, divisions between unions and employees' loyalty. They lacked the insight to manage different actors, and their efforts to outsource services and draw on the Extended Public Works Program failed. They failed to support staff when working beyond their scope of practice, reducing employees' willingness to take on extra responsibilities. In the remaining hospital, while previous management had been removed due to protests by the unions, the new CEO provided stability and union-management relations were collaborative. Her legitimate power enabled unions and management to agree on appropriate cost cutting strategies. ORIGINALITY/VALUE: Finding an appropriate balance between the new reality of reduced financial resources and the needs of staff and patients, requires competent unions and management, transparency and trust to develop legitimate power; managing in an authoritarian manner, without legitimate power, reduces organisational capacity. Ensuring a fair and orderly process to replace ineffective management is key, while South Africa grows cohorts of competent managers and builds managerial experience.

The Struggle to Regulate Precarious Work Arrangements to Minimize Their Adverse Effects on Health and Safety in Australia.

As in other countries, the growth of precarious work arrangements in Australia from the late 1970s has had significant adverse effects on occupational health and safety (OHS). While there is now a large body of global research on this issue and its connection to the rise of neoliberalism, there has been less investigation of efforts to address these problems. This article reviews regulatory interventions in Australia over the past two decades. It particularly focuses on industrial relations regulation, which can play a critical role in addressing at least some of the underlying reasons why precarious work undermines OHS. The most significant of these changes were passed by the Australian Parliament in February 2024, including a highly controversial but world-leading creation of minimum standards for platform workers.

Greening labour? The role of the SDGs in fostering sustainability integration within trade unions.

The effective integration of the economic, social and environmental dimensions of sustainability by actors in all sectors is a core objective of the Sustainable Development Goals (SDGs). Do trade unions, as important socio-economic actors, contribute to this agenda by aligning with environmental concerns? We conducted a qualitative content analysis of primary documentary sources from the International and European Trade Union Confederations focussing on the 2012-2022 period. We complemented this with in-depth interviews from The Netherlands and Belgium. We found that trade unions have been 'greening' their discourses and initiatives, and cooperating more with environmental movements. They also use the SDGs not only as discursive frames, but also to shape concrete initiatives. However, they overwhelmingly see greening still in instrumental terms rather than as a transformative prioritization of environmental concerns. This is reflected in their engagement with the SDGs, as unions shape the implementation of the SDGs according to their priorities.

Principles for Worker-Driven Remedy.

Workers in global supply chains face forced labour, hazardous working conditions, excessive overtime, violence, union busting, and other abuses. They may be cheated of wages and bonuses promised by recruiters or dismissed without due process. They need remedy and, in fact, have a right to an effective remedy, but remedy for business-related harms in global supply chains is rare. The Principles for Worker-Driven Remedy offer a framework for making remedy a reality for workers when their rights are violated and when they are harmed in global supply chains. Developed by Electronics Watch in consultation with trade unions, labour rights organizations, and public buyers, the Principles put affected workers at the heart of the remedy process. Electronics Watch will develop tools and procedures to help public buyers to use the Principles in supplier engagement, tenders, and contract management. We encourage companies and other organizations to adopt and adapt them to address harm to workers in supply chains.

Biomonitoring of Exposures to Solvents and Metals in Electronics Manufacturing Facilities in Batam, Indonesia.

Concerns about chemical exposure in the electronics manufacturing industry have long been recognized, but data are lacking in Southeast Asia. We conducted a study in Batam, Indonesia, to evaluate chemical exposures in electronics facilities, using participatory research and biological monitoring approaches. A convenience sample of 36 workers (28 exposed, 8 controls) was recruited, and urine samples were collected before and after shifts. Five solvents (acetone, methyl ethyl ketone, toluene, benzene, and xylenes) were found in 46%-97% of samples, and seven metals (arsenic, cadmium, cobalt, tin, antimony, lead, and vanadium) were detected in 60%-100% of samples. Biological monitoring and participatory research appeared to be useful in assessing workers' exposure when workplace air monitoring is not feasible due to a lack of cooperation from the employer. Several logistical challenges need to be addressed in future biomonitoring studies of electronics workers in Asia in factories where employers are reluctant to track workers' exposure and health.

Psychological screening, providing social security or strengthening training? How can government and labor unions protect the mental health of young employees.

As the mental health problems of young employees become more and more prominent, the government and labor unions need to take measures to protect the mental health of young employees. Considering that the main mental health safeguard measures are divided into psychological screening, providing social security and strengthening training, this article constructs a differential game model under these three modes. The balanced efforts and social benefits of the government and labor unions under the three modes are obtained, and the applicable conditions of various mental health protection modes are compared. The results show that if the government pays a lower cost, the government gets the highest economic benefit under the training mode, followed by the security mode, and the government gets the lowest economic benefit under the psychological screening mode. If the reputation of the labor unions improved by its efforts is low, the equilibrium benefits of the labor unions under psychological screening and providing security are the same, and greater than the equilibrium benefits under the intensive training mode. If the labor unions have a higher reputation enhanced by its efforts, the balance return of the labor unions under the guarantee mode is the highest, followed by the balance return under the intensive training mode, and the balance return of the labor unions under the psychological screening mode is the lowest.

On the Optimal Size and Composition of Customs Unions: An Evolutionary Approach.

Customs unions enable countries to freely access each other's markets, which is thought to increase intra-regional trade and economic growth. However, accession to a customs union also comes with the condition that all members need to consent to a common external trade policy. Especially if countries feature different economic structures, this may act as a force against the creation of large customs unions. In this paper, we propose a new mathematical approach to model the optimal size and composition of customs unions in the form of a bi-objective combinatorial non-linear problem. We also use a multi-objective evolutionary algorithm (NSGA-II) to search for the best (non-dominated) configurations using data on the trade flows and economic characteristics of 200 countries. Our algorithm identifies 445 different configurations that are strictly preferable, from a global perspective, to the real-world landscape of customs unions. However, many of these non-dominated configurations have the feature that they improve outcomes for the world as a whole, on average, but not for all individual countries. The best configurations tend to favour the creation of a few large customs unions and several smaller ones.

Part-time work: the co-production of a contested employment model for women in Austria and internationally, 1950s to 1980s.

In 2022, every second employed woman in Austria worked part-time, while only 12.6 percent of men did so. In more affluent countries, part-time work has evolved from a special form of employment to a gendered norm in the past six decades, whereas in state-socialist and post-state-socialist Europe, this model of women's employment played a much less pronounced role historically. Albeit contested, part-time work has been a concern of women trade unionists since the 1950s. This article examines the emergence and evolution of an important trend in the history of women's work from a multi-level perspective. It explores how women activists in the ICFTU, the ILO and in Austria dealt with part-time work as a method of harmonizing women's unpaid and paid work. Collaboration with the ILO played an important role in Austrian developments, and Austrian activists aimed to impact on international decision-making. Furthermore, the article shows the rather hidden role women civil servants played in generating knowledge on the topic. This analysis of the evolution of the gendered norm of part-time work and its contestation contributes to recent research on shifts in reproductive arrangements and gender relations in the second half of the twentieth century.

Unions, democracy, and Trump: Deconstructing the COVID-19 vaccination crisis of 2021.

The COVID-19 pandemic has posed significant challenges for U.S. workers, especially those in essential occupations. As most public health experts view vaccination as the only certain path to defeating the virus, this study examines how union membership, political participation, and support for Trump have affected adult vaccination rates. The analyses also explore how these interrelated factors intersect to either exacerbate or reduce the ongoing public health crisis. Using vaccination data from 3112 U.S. counties in July of 2021, this study finds strong support for claims that localities with high levels of support for Trump have lower percentages of adults vaccinated, while areas with higher union coverage and higher voter turnout are associated with higher rates of vaccination. Moreover, the results show that the positive effects of union density are enhanced in counties with higher rates of voter turnout and support for Trump, revealing a complex relationship between unions, democracy and partisan politics. The results suggest that workplace and political democracy can effectively facilitate individual and collective responses to large-scale collective action problems such as the COVID-19 pandemic.

Pharmacokinetic and pharmacodynamic considerations for optimizing antimicrobial therapy used to treat bone and joint infections: an evidence-based algorithmic approach.

INTRODUCTION: Bone and joint infections (BJIs) are a major health concern causing remarkable morbidity and mortality. However, which antimicrobial treatment could be the best according to specific clinical scenarios and/or to the pharmacokinetic/pharmacodynamic (PK/PD) features remains an unmet clinical need. This multidisciplinary opinion article aims to develop evidence-based algorithms for empirical and targeted antibiotic therapy of patients affected by BJIs. AREAS COVERED: A multidisciplinary team of four experts had several rounds of assessment for developing algorithms devoted to empirical and targeted antimicrobial therapy of BJIs. A literature search was performed on PubMed-MEDLINE (until April 2023) to provide evidence for supporting therapeutic choices. Four different clinical scenarios were structured according to specific infection types (i.e. vertebral osteomyelitis, prosthetic joint infections, infected non-unions and other chronic osteomyelitis, and infectious arthritis), need or not of surgical intervention or revision, isolation or not of clinically relevant bacterial pathogens from blood and/or tissue cultures, and PK/PD features of antibiotics. EXPERT OPINION: The proposed therapeutic algorithms were based on a multifaceted approach considering the peculiar features of each antibiotic (spectrum of activity, PK/PD properties, bone penetration rate, and anti-biofilm activity), and could be hopefully helpful in improving clinical outcome of BJIs.

Revisiting the public-private wage gap in Spain: new evidence and interpretation.

This paper updates the available evidence on the public-private wage gap in Spain, which dates back to 2012. Through microdata drawn from the last three waves of the Wage Structure Survey (2010, 2014 and 2018), we study how this gap and its distribution by gender and education have evolved during and after the Great Recession. Conventional Oaxaca-Blinder decompositions are used to divide the raw wage gap into a component explained by differences in characteristics and another one capturing differences in returns and endogenous selection. The main findings are: (i) a strong wage compression by skills, and (ii) a wage premium for less-skilled women in the public sector. Both empirical results can be rationalised by a monopoly union wage-setting model with monopsonistic features and the presence of female statistical discrimination.

Effect of Tricalcium Phosphate on Healing of Non-Unions: An Observational Study of over 400 Non-Unions.

Purpose: A central aspect of the treatment of non-unions is the filling of bone defects. The quantity of available autologous bone for this purpose is limited. Alternatively, or additionally, bone substitutes may be used. The aim of this retrospective, single-center study including 404 non-unions in 393 patients is to investigate the effect of tricalcium phosphate (TCP) on the healing of non-unions. Furthermore, the influence of gender, age, smoking status, comorbidities, type of surgical procedure, presence of infection, and length of treatment was investigated. Methods: We evaluated three groups of patients. Group 1 received TCP + BG, group 2 received BG alone and group 3 received no augmentation. Bone stability was assessed 1 and 2 years after non-union revision surgery through analysis of radiographs using the Lane Sandhu Score. Scores ≥3 were rated as stable Other influencing factors were collected from the electronic medical record. Results: In 224 non-unions, bone defects were filled with autologous bone and TCP (TCP+BG). In 137 non-unions, bone defects were filled with autologous bone (BG), and in 43 non-unions presenting non-relevant defects, neither autologous bone nor TCP were used (NBG). After 2 years, 72.7% of the TCP+BG patients, 90.1% of the BG patients and 84.4% of the NBG patients achieved a consolidation score ≥3. Advanced age, presence of comorbidities and longer treatment period had a significantly negative effect on consolidation 1 year after surgery. Longer treatment periods also showed a negative significant effect after 2 years. It is notable that larger defects, mainly treated with the combination of autologous bone and TCP, showed similar healing rates to that of smaller defects after 2 years. Conclusion: The combination of TCP and autologous bone-grafts shows good results in the reconstruction of complicated bone-defects, but patience is required since the healing period exceeds 1 year in most patients.

Health and Safety Reps in COVID-19-Representation Unleashed?

The paper explores the role of UK union health and safety representatives and changes to representative structures governing workplace and organisational Occupational Health and Safety (OHS) during COVID-19. It draws upon a survey of 648 UK Trade Union Congress (TUC) Health and Safety (H&S) representatives, as well as case studies of 12 organisations in eight key sectors. The survey indicates expanded union H&S representation, but only half of the respondents reported H&S committees in their organisations. Where formal representative mechanisms existed, they provided the basis for more informal day-to-day engagement between management and the union. However, the present study suggests that the legacy of deregulation and the absence of organisational infrastructures meant that the autonomous collective representation of workers' interests over OHS, independent of structures, was crucial to risk prevention. While joint regulation and engagement over OHS was possible in some workplaces, OHS in the pandemic has been contested. Contestation challenges pre-COVID-19 scholarship suggestingthat H&S representatives had been captured by management in the context of unitarist practice. The tension between union power and the wider legal infrastructure remains salient.

Support Decent Work for All as a Public Health Goal in the United States. (APHA Policy Statement Number 20223, Adopted November 2022).

This policy promotes decent work as a U.S. public health goal through a comprehensive approach that builds upon existing APHA policy statements and addresses statement gaps. The International Labour Organization defines decent work as work that is "productive, delivers a fair income, provides security in the workplace and social protection for workers and their families, offers prospects for personal development and encourages social interaction, gives people the freedom to express their concerns and organize and participate in the decisions affecting their lives and guarantees equal opportunities and equal treatment for all across the entire lifespan." The World Health Organization has emphasized that "health and employment are inextricably linked" and "health inequities attributable to employment can be reduced by promoting safe, healthy and secure work." Here evidence is presented linking decent work and health and action steps are proposed to help achieve decent work for all and, thus, improve public health. In the United States, inadequacies in labor laws, structural racism, failed immigration policies, ageism, and other factors have increased income inequality and stressful and hazardous working conditions and reduced opportunities for decent work, adversely affecting workers' health and ability to sustain themselves and their families. The COVID-19 pandemic highlighted these failures through higher mortality rates among essential and low-wage workers, who were disproportionately people of color. This policy statement provides a strategic umbrella of tactics for just, equitable, and healthy economic development of decent work and proposes research partnerships to develop, implement, measure, and evaluate decent work in the United States.

Welfare, Work and the Conditions of Social Solidarity: British Campaigns to Defend Healthcare and Social Security.

When the welfare state is under attack from neoliberal reformers, how can trade unionists and other campaigners build solidarity to defend it? Based on 45 qualitative interviews, this article compares campaigns to defend British health services and social security benefits between 2007 and 2016. Building on the macro-insights of comparative welfare-state literature and the more micro-level insights of studies on mobilisation, community unionism and union strategy, it examines the factors that help or hinder the construction of solidarity. This research finds that building solidarity is more difficult when defending targeted benefits than universal ones, not only because of differences in public opinion and political support for services, but also because the labour process associated with targeting benefits, namely the assessing and sanctioning of clients, can generate conflicts among campaigners.

Safer Sex Negotiation Among Ghanaian Women in Sexual Unions: Does Women's Household Decision-Making Capacity Matter?

Women's ability to negotiate for safer sex has been found to be dependent on their household decision making power. However, there is paucity of studies investigating the association between women's household decision making power and safer sex negotiation in Ghana. Thus, we examined the association between women's household decision making autonomy and safer sex negotiation among Ghanaian women in sexual unions using the 2014 Ghana's Demographic and Health Survey. Descriptive statistics, Chi-square test, and multivariable logistic regression models were performed. Statistical significance was set at p < .05 at 95% confidence interval. The results showed high prevalence of safer sex negotiation among women with high household decision-making capacity (91.6%). Compared to women with low household decision making autonomy, those with high autonomy in household decision making were more likely to negotiate for safer sex (aOR = 2.06; CI = 1.32-3.21). Women aged 25-34 were more likely to negotiate for safer sex compared to those aged 15-24 (aOR = 1.50; CI = 1.07-2.11). Higher odds of safer sex negotiation were found among women with comprehensive HIV and AIDS knowledge (aOR = 1.49; CI = 1.09-2.05), women who had tested for HIV (aOR = 1.57; CI = 1.27-1.95) and those exposed to newspaper (aOR = 1.80; CI = 1.17-2.78) compared to those who had no comprehensive knowledge on HIV and AIDS, those who had never tested for HIV and those who were not exposed to newspaper, respectively. However, women who belonged to other ethnic groups and the Islamic religion had lower odds of safer sex negotiation compared to Akans (aOR = 0.68; CI = 0.48-0.96) and Christian women (aOR = 0.63; CI = 0.46-0.85). Women empowerment programmes need to be intensified to enable Ghanaian women with low household decision making autonomy to negotiate for safer sex with their partners. Ghana could achieve the Sustainable Development Goals (SDGs), particularly, SDG 3.7 (universal access to sexual and reproductive health services), and SDG 5 (achieve gender equality and empower all women and girls) when household decision-making capacity among women is further strengthened.