¿Cómo evolucionó la distribución de médicas y médicos especialistas en Argentina?: un análisis demográfico de la profesión médica al 2020 / How did the distribution of doctors and medical specialists evolve in Argentina?: a demographic analysis of the medical profession to 2020

Las políticas sobre trabajadores/as de salud deben garantizar su distribución adecuada. En Argentina dicha distribución es desigual, sobre todo en especialistas en atención primaria de la salud (APS). El objetivo de este trabajo fue describir la distribución de médicos/as, especialistas lineales y en APS en Argentina, durante el año 2020, teniendo en cuenta la situación económica y sanitaria de cada jurisdicción. Se trata de un trabajo descriptivo y analítico, que utilizó fuentes de datos primarias y secundarias. Se correlacionó la tasa de mortalidad infantil y el producto bruto per cápita de cada jurisdicción ordenándolas de mejores a peores indicadores. La tasa de médicos fue 3,88 médicos/as cada 1000 habitantes, 72% concentrándose en 4 jurisdicciones (Ciudad Autónoma de Buenos Aires, Provincia de Buenos Aires, Córdoba y Santa Fe). El 53% son especialistas y el 27,6% lo son en APS. CABA tuvo una tasa de 16,5 médicos/as por mil; Santiago del Estero y Formosa alcanzaron valores de 1,8 y 1,9 médicas/os por mil habitantes respectivamente. Con respecto a 2014, se observó disminución de especialistas en APS (-14,8%), registrándose las mayores pérdidas en Santiago del Estero, Formosa y Catamarca (-84,5%; -70,1% y -87,3%). La situación nacional sobre la distribución de médicos/as en Argentina desde 1954 a la actualidad fue empeorando en detrimento de las provincias con mayores necesidades. La baja adherencia al sistema de residencias a especialidades de APS pronostica un empeoramiento de la situación de no haber cambios estructurales. Será necesario un fortalecimiento del rol rector del estado en el abordaje de esta problemática (AU)

Policies on health workers must guarantee their adequate distribution. In Argentina, this distribution is unequal, particularly among primary care specialists (PHC).The objective of this article is to describe the distribution of physicians, PHC and non-PHC specialists in Argentina in 2020, considering the economic and health situation of each jurisdiction.We conducted a descriptive cross-sectional study with an analytical stage using primary and secondary data sources. The jurisdictions were classified according to the correlation between infant mortality rate and gross product per capita.The rate of physicians in Argentina in 2020 was 3.88 physicians per 1,000 inhabitants. 72% are concentrated in 4 jurisdictions (City of Buenos Aires, Province of Buenos Aires, Córdoba and Santa Fe). 53% are specialists and 27.6% are PHC specialists. The City of Buenos Aires has a rate of 16.5 physicians per thousand; and Santiago del Estero and Formosa reach values of 1.8 and 1.9 physicians per thousand inhabitants, respectively.There was a decrease in PHC specialists (-14.8%), with major losses recorded in Santiago del Estero, Formosa and Catamarca (-84.5%; -70.1% and -87.3%, respectively).The distribution of physicians in Argentina from 1954 to the present has worsened to the detriment of the provinces with the greatest needs. The lack of adheren-ce to the specialty of PHC predicts a worsening of the situation if there are no structural changes. It is necessary to strengthen the leading role of the state in addressing this problem (AU)

The Impact of Nurse-Led Innovations and Tactics During a Pandemic.

The COVID-19 pandemic hit southeast Michigan hard and a rapid influx of patients forced Beaumont Health to shift rapidly into an emergency management model with a laser focus on transforming clinical care and administrative processes to meet complex patient care needs. Navigating this landscape required agility, surge planning, strong interprofessional teams, transformational leadership, nurse-led innovations, support, and transparency to manage the ever-changing environment. This article explains nursing's response and nurse-led innovations that were implemented to meet the needs of the community, patients, and staff, as well as lessons learned to ensure preparedness for any potential future surge.

Reliability and Validity of a Further Tested Appreciative Management Scale.

BACKGROUND AND PURPOSE: Managers need evidence-based methods to evaluate their management skills. To further test the appreciative management scale (AMS 1.0) to create a practical instrument to be used in evaluating appreciative management. METHODS: For further testing, a new survey was conducted among social and healthcare managers (n = 734) in Finland. Confirmatory factor analysis (CFA) was used to assess the scale validity and Cronbach's alpha coefficients the internal consistency. RESULTS: The validated AMS 2.0 scale includes 24 items. The values measuring validity and reliability were good, with an Rool Mean Square Error of Approximation (RMSEA) of 0.072, Average Variance Extracted (AVE) values between 0.532 and 0.634, and Composite Reliability (CR) values ranging between 0.850 and 0.914. The Cronbach's alpha of the whole scale was 0.944. CONCLUSIONS: AMS 2.0 is a reliable and valid means to measure appreciative management as proved by confirmatory factor analysis.

Work-Family Conflict and Depressive Symptoms Among Chinese Employees: Cross-Level Interaction of Organizational Justice Climate and Family Flexibility.

This study aims to examine how organizational and family factors protect employees from depressive symptoms induced by work-family conflict. With a cross-sectional design, a total of 2184 Chinese employees from 76 departments completed measures of work-family conflict, organizational justice, family flexibility, and depressive symptoms. The results showed that work-family conflict including work-to-family conflict and family-to-work conflict was positively associated with depressive symptoms. In cross-level analysis, organizational justice climate weakened the adverse effect of work-family conflict on depressive symptoms and the buffering effects of procedural and distributive justice climate in the association between work-family conflict and depressive symptoms depended on family flexibility. Specifically, compared with employees with high family flexibility, procedural and distributive justice climate had a stronger buffering effect for employees with low family flexibility. These results indicate that organization and family could compensate each other to mitigate the effect of work-family conflict on employees' depressive symptoms. Cultivating justice climate in organization and enhancing family flexibility might be an effective way to reduce employees' depressive symptoms.

The future of feedback: Motivating performance improvement through future-focused feedback.

Managerial feedback discussions often fail to produce the desired performance improvements. Three studies shed light on why performance feedback fails and how it can be made more effective. In Study 1, managers described recent performance feedback experiences in their work settings. In Studies 2 and 3, pairs of managers role-played a performance review meeting. In all studies, recipients of mixed and negative feedback doubted the accuracy of the feedback and the providers' qualifications to give it. Disagreement regarding past performance was greater following the feedback discussion than before, due to feedback recipients' increased self-protective and self-enhancing attributions. Managers were motivated to improve to the extent they perceived the feedback conversation to be focused on future actions rather than on past performance. Our findings have implications for the theory and practice of performance management.

Worldwide Organization of Neurocritical Care: Results from the PRINCE Study Part 1.

INTRODUCTION: Neurocritical care focuses on the care of critically ill patients with an acute neurologic disorder and has grown significantly in the past few years. However, there is a lack of data that describe the scope of practice of neurointensivists and epidemiological data on the types of patients and treatments used in neurocritical care units worldwide. To address these issues, we designed a multicenter, international, point-prevalence, cross-sectional, prospective, observational, non-interventional study in the setting of neurocritical care (PRINCE Study). METHODS: In this manuscript, we analyzed data from the initial phase of the study that included registration, hospital, and intensive care unit (ICU) organizations. We present here descriptive statistics to summarize data from the registration case report form. We performed the Kruskal-Wallis test followed by the Dunn procedure to test for differences in practices among world regions. RESULTS: We analyzed information submitted by 257 participating sites from 47 countries. The majority of those sites, 119 (46.3%), were in North America, 44 (17.2%) in Europe, 34 (13.3%) in Asia, 9 (3.5%) in the Middle East, 34 (13.3%) in Latin America, and 14 (5.5%) in Oceania. Most ICUs are from academic institutions (73.4%) located in large urban centers (44% > 1 million inhabitants). We found significant differences in hospital and ICU organization, resource allocation, and use of patient management protocols. The highest nursing/patient ratio was in Oceania (100% 1:1). Dedicated Advanced Practiced Providers are mostly present in North America (73.7%) and are uncommon in Oceania (7.7%) and the Middle East (0%). The presence of dedicated respiratory therapist is common in North America (85%), Middle East (85%), and Latin America (84%) but less common in Europe (26%) and Oceania (7.7%). The presence of dedicated pharmacist is highest in North America (89%) and Oceania (85%) and least common in Latin America (38%). The majority of respondents reported having a dedicated neuro-ICU (67% overall; highest in North America: 82%; and lowest in Oceania: 14%). CONCLUSION: The PRINCE Study results suggest that there is significant variability in the delivery of neurocritical care. The study also shows it is feasible to undertake international collaborations to gather global data about the practice of neurocritical care.

What do we know about our agency nurse population? A scoping review.

BACKGROUND: Nurse staffing shortages are often managed by using temporary staff. This review discovers what is known about nurses who choose to work in this way. PROCEDURE: A literature search found eight international studies investigating the lived experience of agency nurses. RESULTS: Nurses actively choose agency nursing to work flexibly and avoid office politics or as a career stop-gap. However, respondents describe feeling isolated, working difficulties with permanent staff and fewer opportunities for training. CONCLUSIONS: Though participants described positive reasons for choosing agency nursing, there were significant downsides. The findings must be viewed in the context of the continued feminized nature of the nursing profession as care responsibilities were cited as a reason for choosing this study pattern. However, the lack of security and provision of adequate pensions and career advancement are considerable issues. The costs of using agency staff are high and consideration must be given to encouraging these nurses into substantive contracts. These individuals show considerable resilience, flexibility, and varied expertise. Such qualities are vital for health care in the 21st century and understanding why they opt out of permanent nursing will enable employers to adapt practices to harness this. Suggestions for practice and further research are presented.

How natural field experiments have enhanced our understanding of unemployment.

Natural field experiments investigating key labour market phenomena such as unemployment have only been used since the early 2000s. This paper reviews the literature and draws three primary conclusions that deepen our understanding of unemployment. First, the inability to monitor workers perfectly in many occupations complicates the hiring decision in a way that contributes to unemployment. Second, the inability to determine a worker's attributes precisely at the time of hiring leads to discrimination on the basis of factors such as race, gender, age and ethnicity. This can lead to systematically high and persistent levels of unemployment for groups that face discrimination. Third, the importance of social and personal dynamics in the workplace can lead to short-term unemployment. Much of the knowledge necessary for these conclusions could only be obtained using natural field experiments due to their ability to combine randomized control with an absence of experimenter demand effects.

Relatório anual de gestão da secretaria estadual de saúde: exercício 2019 / Annual management report of the state health department: exercise 2019

Apresenta o resumo das ações desenvolvidas em 2019 no âmbito da Saúde no Estado do Tocantins.

It presents the summary of the actions developed in 2019 in the scope of Health in the State of Tocantins.

Presenta el resumen de las acciones desarrolladas en 2019 en el ámbito de la Salud en el Estado de Tocantins.

Il présente la synthèse des actions développées en 2019 dans le cadre de la Santé dans l'Etat de Tocantins.

Effects of Payment for Performance on accountability mechanisms: Evidence from Pwani, Tanzania.

Payment for Performance (P4P) aims to improve provider motivation to perform better, but little is known about the effects of P4P on accountability mechanisms. We examined the effect of P4P in Tanzania on internal and external accountability mechanisms. We carried out 93 individual in-depth interviews, 9 group interviews and 19 Focus Group Discussions in five intervention districts in three rounds of data collection between 2011 and 2013. We carried out surveys in 150 health facilities across Pwani region and four control districts, and interviewed 200 health workers, before the scheme was introduced and 13 months later. We examined the effects of P4P on internal accountability mechanisms including management changes, supervision, and priority setting, and external accountability mechanisms including provider responsiveness to patients, and engagement with Health Facility Governing Committees. P4P had some positive effects on internal accountability, with increased timeliness of supervision and the provision of feedback during supervision, but a lack of effect on supervision intensity. P4P reduced the interruption of service delivery due to broken equipment as well as drug stock-outs due to increased financial autonomy and responsiveness from managers. Management practices became less hierarchical, with less emphasis on bureaucratic procedures. Effects on external accountability were mixed, health workers treated pregnant women more kindly, but outreach activities did not increase. Facilities were more likely to have committees but their role was largely limited. P4P resulted in improvements in internal accountability measures through improved relations and communication between stakeholders that were incentivised at different levels of the system and enhanced provider autonomy over funds. P4P had more limited effects on external accountability, though attitudes towards patients appeared to improve, community engagement through health facility governing committees remained limited. Implementers should examine the lines of accountability when setting incentives and deciding who to incentivise in P4P schemes.

Further examination of predictors of turnover intention among mental health professionals.

WHAT IS KNOWN ON THE SUBJECT?: When mental health professionals leave organizations, detrimental effects on quality of patient care occur. Reasons for leaving include incivility, lack of autonomy, perceptions of unfair treatment and feeling psychologically unsafe at work. This paper sought to investigate additional reasons why mental health professionals intend to quit or to cognitively withdraw from their jobs. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: Past research on this topic is limited in its scope and data. Mainly fragmented evidence is available about predictors of job satisfaction and turnover intention (i.e. different mental health occupations examined in separate studies). Only two existing studies that examined broader mental health provider groups were limited by including few workforce settings, small sample sizes and insufficiently rigorous statistical analyses. We examined four occupations (mental health nurses, social workers, psychologists and psychiatrists), each represented through a large sample in multiple settings, all within one large healthcare network with complex patients. Our contribution is finding additional predictors (supervisory support, emotional exhaustion) of job satisfaction/turnover intention. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Organizations can consider using culture change initiatives to increase civility at work; this includes leadership support and role modelling of workplace behaviours. Leaders should monitor staffing levels and high workloads to pre-empt emotional exhaustion, which predicts turnover. Hiring and training supervisors should involve not only technical expertise, but also 'soft skills' necessary for creating civil and supportive work environments. Leaders and managers should use employee feedback data (e.g. organizational surveys) to learn about the workplace environments, and address areas of employees' concern. ABSTRACT: Introduction Given the global shortage of mental health professionals, high turnover rates within this workforce are concerning. We used United States of America Veterans Health Administration data to add to the limited knowledge about this topic. Aim We examined predictors of turnover intention, or an employee's cognitive withdrawal from their job, in a large sample of direct care mental health professionals, separating among occupations to increase the pragmatic relevance of our findings. Method Survey data from 10 997 mental health employees working in direct patient contact (2432 registered nurses, 3769 social workers, 2520 psychologists and 1276 psychiatrists) were used in a cross-sectional design with structural equation modelling techniques for model testing. Results Job satisfaction was predicted by civility (courteous and respectful workplace behaviours) and supervisory support. Job satisfaction predicted emotional exhaustion which predicted turnover intention. Job satisfaction also directly predicted turnover intention and turnover plans. Discussion Predictors of job satisfaction included civility and supervisory support. Emotional exhaustion predicted turnover intention. Results inform organizational actions to address these work environment characteristics. Implications for practice Organizations can initiate culture changes to improve civility and develop supervisors' 'soft skills' in conjunction with technical expertise.

Assessment of infection control practices in teaching hospitals of Quetta.

OBJECTIVE: To identify the gaps in infection control and prevention practices in teaching hospitals. METHODS: This cross-sectional study was conducted at Bolan Medical Complex and Sandeman Medical College Hospital, Quetta, from August 2012 to January 2013.The study comprised members (n=7) of infection control committee who were interviewed through a self-developed, closed-ended questionnaire and their perception regarding infection control and prevention was recorded. Data was analysed using SPSS 16. RESULTS: Only 3(42.9%) of the committee members believed that the administrative factors for causing hospital-acquired infections were nurse-patient ratio. On the patient care side, 1(14.3%) participants at one of the hospitals attributed infections to antibiotic use, 5(71.4%) to invasive medical device and 1(14.3%) to other factors. CONCLUSIONS: Poor perception held by the members of infection control committee was the basic cause of bad outcome. Capacity-building of all the stakeholders is required.

Analysis of patient falls among hospitalised patients in Makkah region.

OBJECTIVE: To assess the frequency and its correlation of patient fall with preventing or precipitating factors among inpatients. METHODS: The observational study was conducted in Makkah Region, Saudi Arabia from October 15 2012 to November 4, 2013. Data was collected using a questionnaire from 16 hospitals in four districts of Makkah province. The material was sampled through systematic randomisation from inpatient files and data was collected for those who had fallen inside the hospital. The questionnaire, validated through a pilot study run under the Directorate of Quality and Patient Safety in Makkah, was used to see whether the hospitals had adopted and applied international standards for assessment of adult and paediatric patients for falls as well as effectiveness of these applications. RESULTS: Of 4,799 beds, occupancy rates ranged from 1680(35%) to 4,799(100%). Out of 291 falls in all, 144(49.48%) were in Jeddah. Besides, 116(40%) of the falls occurred in the last quarter of the Islamic calendar. Statistically significant difference was found in fall episodes in different months (p=0.007). Statistical analysis indicated that the factors that significantly raised the number of patient falls were increase in hospital beds and their occupancy rate (Spearman's correlation: 0.621 and 0.579 respectively). CONCLUSIONS: The frequency of falls varied from hospital to hospital and factors like higher number of bed capacity and occupancy rate increased the falls.

Staying at the Cutting Edge: Partnership With a Level 1 Trauma Center Improves Clinical Currency and Wartime Readiness for Military Surgeons.

INTRODUCTION: Surgical currency is a critical component of medical corps readiness. We report a review of surgeons embedded into a civilian institution and analyze whether this improves surgical currency and wartime readiness. METHODS: Patient management and operative volume were acquired from four surgeons embedded at a civilian institution and compared to operative case loads of surgeons based at a military treatment facility (MTF). RESULTS: The surgeons embedded in the civilian institution had a mean of 49.3 cases compared to a mean of 8.3 cases for surgeons at the MTF over this 6-month period. In addition, the embedded surgeons obtained 44.4 to 94.7% of these cases during their civilian experience as opposed to cases done at the MTF. The cases performed by the embedded orthopedic surgeon (n = 247) was over 20 times the mean number of cases (mean = 12) performed at the MTF. Over a 6-month period, the trauma surgeon and general surgeon each evaluated 150 and 170 new trauma patients, respectively. In addition, the trauma/critical care surgeon cared for 250 critical care patients over this same 6-month period. CONCLUSION: This study demonstrates that embedding surgeons into a civilian institution allows them to maintain skill sets critical for currency and wartime readiness.

Military, demographic, and psychosocial predictors of military retention in enlisted army soldiers 12 months after deployment to Iraq.

OBJECTIVE: To examine military, demographic, and psychosocial predictors of military retention following operational deployment. METHODS: Military status 12 months following return from Iraq deployment was assessed via service records in 740 regular active duty Army Soldiers. Potential predictors of military retention were derived from prospectively administered in-person interviews and questionnaires conducted within 3 months following return from Iraq. RESULTS: At 12 months following return from deployment, 18.1% (n = 134) of the sample had separated from military service. Cox proportional hazards analyses, adjusting for demographic, military, and psychosocial predictors, identified several factors that were independently associated with military attrition: less than (vs. equal to or more than) 6 years military experience (hazards ratio [HR], 3.98; 95% CI, 2.12-7.45); unmarried (vs. married) status (HR, 1.51; 95% CI, 1.06-2.16); and lower (vs. higher) levels of self-reported unit support during deployment (HR, 2.22; 95% CI, 1.42-3.47). CONCLUSIONS: Service members early in their career may be especially prone to military attrition. With regard to military retention, our findings suggest that it may be particularly important to develop initiatives that target organizational cohesion and support.

Addressing disparities in academic medicine: what of the minority tax?

BACKGROUND: The proportion of black, Latino, and Native American faculty in U.S. academic medical centers has remained almost unchanged over the last 20 years. Some authors credit the "minority tax"-the burden of extra responsibilities placed on minority faculty in the name of diversity. This tax is in reality very complex, and a major source of inequity in academic medicine. DISCUSSION: The "minority tax" is better described as an Underrepresented Minority in Medicine (URMM) faculty responsibility disparity. This disparity is evident in many areas: diversity efforts, racism, isolation, mentorship, clinical responsibilities, and promotion. The authors examine the components of the URMM responsibility disparity and use information from the medical literature and from human resources to suggest practical steps that can be taken by academic leaders and policymakers to move toward establishing faculty equity and thus increase the numbers of black, Latino, and Native American faculty in academic medicine.

Supervisor Autonomy and Considerate Leadership Style are Associated with Supervisors' Likelihood to Accommodate Back Injured Workers.

PURPOSE: To determine the association between supervisors' leadership style and autonomy and supervisors' likelihood of supporting job accommodations for back-injured workers. METHODS: A cross-sectional study of supervisors from Canadian and US employers was conducted using a web-based, self-report questionnaire that included a case vignette of a back-injured worker. Autonomy and two dimensions of leadership style (considerate and initiating structure) were included as exposures. The outcome, supervisors' likeliness to support job accommodation, was measured with the Job Accommodation Scale (JAS). We conducted univariate analyses of all variables and bivariate analyses of the JAS score with each exposure and potential confounding factor. We used multivariable generalized linear models to control for confounding factors. RESULTS: A total of 796 supervisors participated. Considerate leadership style (ß = .012; 95% CI .009-.016) and autonomy (ß = .066; 95% CI .025-.11) were positively associated with supervisors' likelihood to accommodate after adjusting for appropriate confounding factors. An initiating structure leadership style was not significantly associated with supervisors' likelihood to accommodate (ß = .0018; 95% CI -.0026 to .0061) after adjusting for appropriate confounders. CONCLUSIONS: Autonomy and a considerate leadership style were positively associated with supervisors' likelihood to accommodate a back-injured worker. Providing supervisors with more autonomy over decisions of accommodation and developing their considerate leadership style may aid in increasing work accommodation for back-injured workers and preventing prolonged work disability.